Provider Demographics
NPI:1619246808
Name:OCVT WESTLAKE CORPORATION
Entity Type:Organization
Organization Name:OCVT WESTLAKE CORPORATION
Other - Org Name:THE OPTOMETRY CENTER FOR VISION THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIANA
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:OD, FCOVD
Authorized Official - Phone:512-614-1640
Mailing Address - Street 1:6836 BEE CAVES RD
Mailing Address - Street 2:BLDG 1, SUITE 100
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78746-5070
Mailing Address - Country:US
Mailing Address - Phone:512-614-1640
Mailing Address - Fax:512-614-1645
Practice Address - Street 1:6836 BEE CAVES RD
Practice Address - Street 2:SUITE 100
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746-5070
Practice Address - Country:US
Practice Address - Phone:512-614-1640
Practice Address - Fax:512-614-1645
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-19
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX152W00000X, 152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WV0400XEye and Vision Services ProvidersOptometristVision TherapyGroup - Single Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty