Provider Demographics
NPI:1649520164
Name:BRISTOL FAMILY EYECARE, PC
Entity type:Organization
Organization Name:BRISTOL FAMILY EYECARE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:BRISTOL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:512-263-3937
Mailing Address - Street 1:11500 BEE CAVES RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78738-5536
Mailing Address - Country:US
Mailing Address - Phone:512-263-3937
Mailing Address - Fax:512-263-3940
Practice Address - Street 1:11500 BEE CAVES RD
Practice Address - Street 2:SUITE 100
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78738-5536
Practice Address - Country:US
Practice Address - Phone:512-263-3937
Practice Address - Fax:512-263-3940
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-12
Last Update Date:2012-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7658TG152W00000X
TX5613TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty