Provider Demographics
NPI:1639403363
Name:MASTER EYE ASSOCIATES OPTOMETRIC SERVICES OF TEXAS PC
Entity Type:Organization
Organization Name:MASTER EYE ASSOCIATES OPTOMETRIC SERVICES OF TEXAS PC
Other - Org Name:SENIORS EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:RANDALL
Authorized Official - Last Name:LACEY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:512-263-0020
Mailing Address - Street 1:16306 E LAKE SHORE DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78734-1132
Mailing Address - Country:US
Mailing Address - Phone:512-263-0020
Mailing Address - Fax:512-263-4623
Practice Address - Street 1:16306 E LAKE SHORE DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78734-1132
Practice Address - Country:US
Practice Address - Phone:512-263-0020
Practice Address - Fax:512-263-4623
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-29
Last Update Date:2009-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1611543-01Medicaid