Provider Demographics
NPI:1922231810
Name:AUSTIN DIAGNOSTIC CLINIC, PA
Entity Type:Organization
Organization Name:AUSTIN DIAGNOSTIC CLINIC, PA
Other - Org Name:AUSTIN DIAGNOSTIC CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:W
Authorized Official - Last Name:SPURCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-901-4403
Mailing Address - Street 1:12221 N MO PAC EXPY
Mailing Address - Street 2:OPTOMETRIST
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78758-2401
Mailing Address - Country:US
Mailing Address - Phone:512-901-4014
Mailing Address - Fax:512-901-3914
Practice Address - Street 1:12221 N MO PAC EXPY
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78758-2401
Practice Address - Country:US
Practice Address - Phone:512-901-4014
Practice Address - Fax:512-901-3914
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AUSTIN DIAGNOSTIC CLINIC, PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-08-26
Last Update Date:2010-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00D87VMedicare PIN