Provider Demographics
NPI:1619262417
Name:STARS IN YOUR EYES VISION TRAINING CENTER LLC
Entity Type:Organization
Organization Name:STARS IN YOUR EYES VISION TRAINING CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHOTTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:512-419-1212
Mailing Address - Street 1:3305 NORTHLAND DR STE 312
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-4961
Mailing Address - Country:US
Mailing Address - Phone:512-419-1212
Mailing Address - Fax:
Practice Address - Street 1:3305 NORTHLAND DR STE 312
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-4961
Practice Address - Country:US
Practice Address - Phone:512-419-1212
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-09
Last Update Date:2011-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5531T152WP0200X, 152WS0006X
TN5531T152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WV0400XEye and Vision Services ProvidersOptometristVision TherapyGroup - Single Specialty
No152WP0200XEye and Vision Services ProvidersOptometristPediatricsGroup - Single Specialty
No152WS0006XEye and Vision Services ProvidersOptometristSports VisionGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX5531TOtherTEXAS BOARD OF OPTOMETRY