Provider Demographics
NPI:1922001270
Name:AUTRY, JILL (OD)
Entity Type:Individual
Prefix:DR
First Name:JILL
Middle Name:
Last Name:AUTRY
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 1:6565 WEST LOOP S
Mailing Address - Street 2:SUITE 650
Mailing Address - City:BELLAIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77401-3500
Mailing Address - Country:US
Mailing Address - Phone:713-797-1010
Mailing Address - Fax:713-357-7276
Practice Address - Street 1:6565 WEST LOOP S
Practice Address - Street 2:SUITE 650
Practice Address - City:BELLAIRE
Practice Address - State:TX
Practice Address - Zip Code:77401-3500
Practice Address - Country:US
Practice Address - Phone:713-797-1010
Practice Address - Fax:713-735-7727
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2015-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5966TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX151618902Medicaid
TX151618901Medicaid
TX00556PMedicare PIN
TX151618901Medicaid
TX151618902Medicaid