Provider Demographics
NPI:1740031160
Name:SIA VIP PLLC
Entity type:Organization
Organization Name:SIA VIP PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DO
Authorized Official - Prefix:DR
Authorized Official - First Name:IRINA
Authorized Official - Middle Name:
Authorized Official - Last Name:VOLOSKO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:415-570-1275
Mailing Address - Street 1:4207 JAMES CASEY ST STE 303
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78745-1193
Mailing Address - Country:US
Mailing Address - Phone:512-443-2046
Mailing Address - Fax:
Practice Address - Street 1:4207 JAMES CASEY ST STE 303
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-1193
Practice Address - Country:US
Practice Address - Phone:512-443-2046
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SIA VIP PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-04-01
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207WX0009XAllopathic & Osteopathic PhysiciansOphthalmologyGlaucoma SpecialistGroup - Single Specialty