Provider Demographics
NPI:1346213774
Name:PIERCE, JACK WILLIAM (MD)
Entity Type:Individual
Prefix:DR
First Name:JACK
Middle Name:WILLIAM
Last Name:PIERCE
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Gender:M
Credentials:MD
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Mailing Address - Street 1:3300 W ANDERSON LN
Mailing Address - Street 2:SUITE 308
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78757-1036
Mailing Address - Country:US
Mailing Address - Phone:512-454-8744
Mailing Address - Fax:512-451-3447
Practice Address - Street 1:3300 W ANDERSON LN
Practice Address - Street 2:SUITE 308
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78757-1036
Practice Address - Country:US
Practice Address - Phone:512-454-8744
Practice Address - Fax:512-451-3447
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2008-10-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXF9956207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX137143711Medicaid
TX8AE830OtherBCBS OF TEXAS INDIVIDUAL #
TXC20521Medicare UPIN
TX137143711Medicaid