Provider Demographics
NPI:1700931565
Name:STURGEON, RAVINA (OD)
Entity Type:Individual
Prefix:
First Name:RAVINA
Middle Name:
Last Name:STURGEON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11425 DONA VILLA DR.
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78726-1727
Mailing Address - Country:US
Mailing Address - Phone:512-535-0137
Mailing Address - Fax:512-996-0477
Practice Address - Street 1:8201 N FM 620
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78726
Practice Address - Country:US
Practice Address - Phone:512-328-2015
Practice Address - Fax:512-996-0477
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6881T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist