Provider Demographics
NPI:1982854881
Name:JEFFREY K AUSTIN OD LTD
Entity Type:Organization
Organization Name:JEFFREY K AUSTIN OD LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/DOCTOR OF OPTOMETRY
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:K
Authorized Official - Last Name:AUSTIN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:702-485-5000
Mailing Address - Street 1:501 S RANCHO DR
Mailing Address - Street 2:G-46
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89106-4828
Mailing Address - Country:US
Mailing Address - Phone:702-485-5000
Mailing Address - Fax:702-485-5001
Practice Address - Street 1:501 S RANCHO DR
Practice Address - Street 2:G-46
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-4828
Practice Address - Country:US
Practice Address - Phone:702-485-5000
Practice Address - Fax:702-485-5001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-27
Last Update Date:2008-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV220152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVU59839Medicare UPIN