Basic Information
| Provider Information | |||||||||
| NPI: | 1679737027 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | STARS IN YOUR EYES OPTOMETRY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 714 CONGRESS AVE STE 100 | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787013428 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5124779000 | ||||||||
| FaxNumber: | 5124779105 | ||||||||
| Practice Location | |||||||||
| Address1: | 714 CONGRESS AVE STE 100 | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787013428 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5124779000 | ||||||||
| FaxNumber: | 5124779105 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/15/2008 | ||||||||
| LastUpdateDate: | 07/15/2008 | ||||||||
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| AuthorizedOfficialLastName: | SCHOTTMAN | ||||||||
| AuthorizedOfficialFirstName: | EMILY | ||||||||
| AuthorizedOfficialMiddleName: | H. | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER / OPTOMETRIST | ||||||||
| AuthorizedOfficialTelephone: | 5124779000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | OD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 5531T | TX | Y | 193400000X SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | 81309Q | 01 | TX | BCBS | OTHER |