Provider Demographics
NPI:1497430953
Name:GREAT HILLS EYE CARE, PC
Entity Type:Organization
Organization Name:GREAT HILLS EYE CARE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DREW
Authorized Official - Middle Name:
Authorized Official - Last Name:PROVOST
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:512-934-4444
Mailing Address - Street 1:10401 RESEARCH BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-5712
Mailing Address - Country:US
Mailing Address - Phone:512-345-2000
Mailing Address - Fax:512-345-2002
Practice Address - Street 1:2201 N I-35
Practice Address - Street 2:STE A
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78628
Practice Address - Country:US
Practice Address - Phone:512-793-7931
Practice Address - Fax:512-790-0991
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GREAT HILLS EYE CARE, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-06-21
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty