Provider Demographics
NPI:1831320837
Name:PIONEER VISION PA
Entity Type:Organization
Organization Name:PIONEER VISION PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPEUTIC OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FELL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:512-388-7600
Mailing Address - Street 1:4010 SANDY BROOK DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78665-1512
Mailing Address - Country:US
Mailing Address - Phone:512-388-7600
Mailing Address - Fax:512-388-7601
Practice Address - Street 1:4010 SANDY BROOK DR
Practice Address - Street 2:SUITE 101
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78665-1512
Practice Address - Country:US
Practice Address - Phone:512-388-7600
Practice Address - Fax:512-388-7601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-07
Last Update Date:2009-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6782TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty