Provider Demographics
NPI:1477809606
Name:BUDA VISION SOURCE PLLC
Entity Type:Organization
Organization Name:BUDA VISION SOURCE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OD
Authorized Official - Prefix:
Authorized Official - First Name:TONY
Authorized Official - Middle Name:PHILIP
Authorized Official - Last Name:JACOB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-398-7600
Mailing Address - Street 1:3310 FM 967 # B
Mailing Address - Street 2:SUITE A-108
Mailing Address - City:BUDA
Mailing Address - State:TX
Mailing Address - Zip Code:78610-3487
Mailing Address - Country:US
Mailing Address - Phone:512-295-0076
Mailing Address - Fax:512-312-4265
Practice Address - Street 1:3310 FM 967 # B
Practice Address - Street 2:SUITE A-108
Practice Address - City:BUDA
Practice Address - State:TX
Practice Address - Zip Code:78610-3487
Practice Address - Country:US
Practice Address - Phone:432-413-1997
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-25
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7392152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty