Provider Demographics
NPI:1538675764
Name:BLUEBONNET OPTICAL LLC.
Entity Type:Organization
Organization Name:BLUEBONNET OPTICAL LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:ARELLANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-573-1173
Mailing Address - Street 1:1617 PARKSIDE CIR
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78664-6966
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1617 PARKSIDE CIR
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78664-6966
Practice Address - Country:US
Practice Address - Phone:512-766-3025
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-26
Last Update Date:2019-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty