Provider Demographics
NPI:1275871675
Name:JT JOLLY GOOD EYE CARE PLLC
Entity Type:Organization
Organization Name:JT JOLLY GOOD EYE CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:
Authorized Official - Last Name:BRUEGGEMANN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:469-693-1426
Mailing Address - Street 1:14900 AVERY RANCH BLVD
Mailing Address - Street 2:STE C200, #308
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78717-3951
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12625 N IH 35
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78753-1074
Practice Address - Country:US
Practice Address - Phone:512-293-7587
Practice Address - Fax:512-989-2879
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-21
Last Update Date:2013-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7467TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty