Provider Demographics
NPI:1508003146
Name:AUSTIN, JAMES ROBERT (O,D)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:ROBERT
Last Name:AUSTIN
Suffix:
Gender:M
Credentials:O,D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 LAKESIDE DR
Mailing Address - Street 2:
Mailing Address - City:LEVITTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19054-3901
Mailing Address - Country:US
Mailing Address - Phone:215-946-1926
Mailing Address - Fax:
Practice Address - Street 1:1 LAKESIDE DR
Practice Address - Street 2:
Practice Address - City:LEVITTOWN
Practice Address - State:PA
Practice Address - Zip Code:19054-3901
Practice Address - Country:US
Practice Address - Phone:215-946-1926
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-20
Last Update Date:2009-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOE003528L152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist