Provider Demographics
NPI:1205122553
Name:GEORGETOWN VISION CENTER PLLC
Entity type:Organization
Organization Name:GEORGETOWN VISION CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:STURM
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:812-391-0384
Mailing Address - Street 1:1013 W UNIVERSITY AVE
Mailing Address - Street 2:STE 135
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78628-5340
Mailing Address - Country:US
Mailing Address - Phone:512-869-8821
Mailing Address - Fax:512-869-8849
Practice Address - Street 1:1013 W UNIVERSITY AVE
Practice Address - Street 2:STE 135
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78628-5340
Practice Address - Country:US
Practice Address - Phone:512-869-8821
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-24
Last Update Date:2011-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty