Provider Demographics
NPI:1831444934
Name:LAKE AUSTIN EYE PLLC
Entity type:Organization
Organization Name:LAKE AUSTIN EYE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GINA
Authorized Official - Middle Name:R
Authorized Official - Last Name:COTTLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-263-1113
Mailing Address - Street 1:3944 RR 620 S STE 222
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78738-7000
Mailing Address - Country:US
Mailing Address - Phone:512-263-1113
Mailing Address - Fax:512-263-1119
Practice Address - Street 1:11614 BEE CAVES RD STE 110
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78738-5551
Practice Address - Country:US
Practice Address - Phone:512-263-1113
Practice Address - Fax:512-263-1119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-16
Last Update Date:2019-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty