Provider Demographics
NPI:1275782914
Name:THE OPTOMETRY CENTER FOR VISION THERAPY CORP
Entity Type:Organization
Organization Name:THE OPTOMETRY CENTER FOR VISION THERAPY CORP
Other - Org Name:THE OPTOMETRY CENTER FOR VISION THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIANA
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:OD, FCOVD
Authorized Official - Phone:512-401-0400
Mailing Address - Street 1:10601 PECAN PARK BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78750-1325
Mailing Address - Country:US
Mailing Address - Phone:512-401-0400
Mailing Address - Fax:512-401-0403
Practice Address - Street 1:10601 PECAN PARK BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78750-1325
Practice Address - Country:US
Practice Address - Phone:512-401-0400
Practice Address - Fax:512-401-0403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-18
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7197T152W00000X, 152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WV0400XEye and Vision Services ProvidersOptometristVision TherapyGroup - Single Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty