Provider Demographics
NPI:1508040429
Name:EYE COUNTRY PLLC
Entity Type:Organization
Organization Name:EYE COUNTRY PLLC
Other - Org Name:HANS OOSTERBAAN, OD
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:830-997-0131
Mailing Address - Street 1:1102 NORTH LLANO STREET
Mailing Address - Street 2:SUITE A
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78624-5449
Mailing Address - Country:US
Mailing Address - Phone:830-997-0131
Mailing Address - Fax:866-897-9855
Practice Address - Street 1:1102 NORTH LLANO STREET
Practice Address - Street 2:SUITE A
Practice Address - City:FREDERICKSBURG
Practice Address - State:TX
Practice Address - Zip Code:78624-5449
Practice Address - Country:US
Practice Address - Phone:830-997-0131
Practice Address - Fax:866-897-9855
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-27
Last Update Date:2015-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4526TG152W00000X, 332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No332H00000XSuppliersEyewear SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX093435802Medicaid
TX0994820001Medicare NSC