Provider Demographics
NPI:1568607729
Name:ROGER A. DUKE, O.D., LLC
Entity Type:Organization
Organization Name:ROGER A. DUKE, O.D., LLC
Other - Org Name:AUSTIN EYECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:DUKE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:512-443-4317
Mailing Address - Street 1:4409 MANCHACA RD
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78745-1603
Mailing Address - Country:US
Mailing Address - Phone:512-443-4317
Mailing Address - Fax:512-443-0882
Practice Address - Street 1:4409 MANCHACA RD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-1603
Practice Address - Country:US
Practice Address - Phone:512-443-4317
Practice Address - Fax:512-443-0882
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-02
Last Update Date:2009-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX02775TG152W00000X, 152WC0802X, 152WL0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Multi-Specialty
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision RehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0086RNOtherBLUE CROSS BLUE SHIELD OF TEXAS