Provider Demographics
NPI:1467857771
Name:CLEARLY EYECARE, LLC
Entity Type:Organization
Organization Name:CLEARLY EYECARE, LLC
Other - Org Name:TERAVISTA VISION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:THERAPEUTIC OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NGAN
Authorized Official - Middle Name:K
Authorized Official - Last Name:TO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:512-698-0248
Mailing Address - Street 1:1758 CRICKET HOLLOW DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78758-4274
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1758 CRICKET HOLLOW DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78758-4274
Practice Address - Country:US
Practice Address - Phone:512-698-0248
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-29
Last Update Date:2014-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8170TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty