Provider Demographics
NPI:1407826415
Name:WATERLOO EYE ASSOCIATES
Entity Type:Organization
Organization Name:WATERLOO EYE ASSOCIATES
Other - Org Name:HILL COUNTRY EYE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:RESTIVO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-528-1144
Mailing Address - Street 1:12171 W PARMER LN
Mailing Address - Street 2:SUITE 201
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-7361
Mailing Address - Country:US
Mailing Address - Phone:512-528-1144
Mailing Address - Fax:512-528-1143
Practice Address - Street 1:12171 W PARMER LN
Practice Address - Street 2:SUITE 201
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-7361
Practice Address - Country:US
Practice Address - Phone:512-528-1144
Practice Address - Fax:512-528-1143
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-23
Last Update Date:2012-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0059MSOtherBCBS OF TEXAS GROUP #
TX173907001Medicaid
TX173907001Medicaid