Provider Demographics
NPI:1710112511
Name:GORN, JULIE (OD)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:GORN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6303 MOUNTAIN PARK CV
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-2611
Mailing Address - Country:US
Mailing Address - Phone:201-488-0696
Mailing Address - Fax:
Practice Address - Street 1:2901 S CAPITAL OF TEXAS HWY
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746-8101
Practice Address - Country:US
Practice Address - Phone:512-329-6092
Practice Address - Fax:512-330-9941
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-21
Last Update Date:2017-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV006912152W00000X
TX8622T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist