Provider Demographics
NPI:1881615433
Name:TANGLEWOOD VISION CENTER, PLLC
Entity type:Organization
Organization Name:TANGLEWOOD VISION CENTER, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER /
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:MCGOWAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:512-280-0520
Mailing Address - Street 1:2110 SLAUGHTER LN W
Mailing Address - Street 2:STE 129
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78748-5992
Mailing Address - Country:US
Mailing Address - Phone:512-280-0520
Mailing Address - Fax:512-280-1656
Practice Address - Street 1:2110 SLAUGHTER LN W
Practice Address - Street 2:STE 129
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78748-5992
Practice Address - Country:US
Practice Address - Phone:512-280-0520
Practice Address - Fax:512-280-1656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2018-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
152W00000X
TX5582TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00178PMedicare ID - Type Unspecified