Provider Demographics
NPI:1407131865
Name:EYE COUNTRY PLLC
Entity Type:Organization
Organization Name:EYE COUNTRY PLLC
Other - Org Name:EYE COUNTRY LLANO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:830-997-0131
Mailing Address - Street 1:1903 FORD ST
Mailing Address - Street 2:STE 3
Mailing Address - City:LLANO
Mailing Address - State:TX
Mailing Address - Zip Code:78643-2912
Mailing Address - Country:US
Mailing Address - Phone:325-247-5469
Mailing Address - Fax:866-897-9855
Practice Address - Street 1:1903 S FORD ST
Practice Address - Street 2:SUITE 3
Practice Address - City:LLANO
Practice Address - State:TX
Practice Address - Zip Code:78643
Practice Address - Country:US
Practice Address - Phone:325-247-5469
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-18
Last Update Date:2012-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty