Provider Demographics
NPI:1366848251
Name:TIMBERWILDE EYE CARE, PLLC
Entity Type:Organization
Organization Name:TIMBERWILDE EYE CARE, PLLC
Other - Org Name:TEXAS STATE OPTICAL NORTH SPRING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROOF
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:832-851-8186
Mailing Address - Street 1:PO BOX 130958
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77393-0958
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:24504 KUYKENDAHL DR
Practice Address - Street 2:SUITE 500
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77389
Practice Address - Country:US
Practice Address - Phone:832-851-8186
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-05
Last Update Date:2016-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7956152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty