Provider Demographics
NPI:1245530336
Name:AVERY RANCH EYE CARE, PLLC
Entity type:Organization
Organization Name:AVERY RANCH EYE CARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:VINCENT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:512-528-8299
Mailing Address - Street 1:15004 AVERY RANCH BLVD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78717-4600
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:15004 AVERY RANCH BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78717-4600
Practice Address - Country:US
Practice Address - Phone:512-528-8299
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-24
Last Update Date:2010-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX07484TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX07484TGOtherSTATE OPTOMETRY LICENSE