Provider Demographics
NPI:1417279480
Name:LEANDER EYE CARE PC
Entity Type:Organization
Organization Name:LEANDER EYE CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OD
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:A
Authorized Official - Last Name:PRESCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:512-259-8484
Mailing Address - Street 1:1395 SOUTH U.S. HIGHWAY 183
Mailing Address - Street 2:SUITE 130
Mailing Address - City:LEANDER
Mailing Address - State:TX
Mailing Address - Zip Code:78641
Mailing Address - Country:US
Mailing Address - Phone:512-259-8484
Mailing Address - Fax:713-995-0548
Practice Address - Street 1:1395 SOUTH U.S. HIGHWAY 183
Practice Address - Street 2:SUITE 130
Practice Address - City:LEANDER
Practice Address - State:TX
Practice Address - Zip Code:78641
Practice Address - Country:US
Practice Address - Phone:512-259-8484
Practice Address - Fax:713-995-0548
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-18
Last Update Date:2011-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6974T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX212078401Medicaid
TX6974TOtherOPTOMETRY LICENSE
TX0A6211Medicare PIN
TX212078401Medicaid