Individual
DR. BOB JOE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
8105 SHOAL CREEK BLVD, SUITE A, AUSTIN, TX 78757-8040
(512) 454-4641
(512) 454-1065
Mailing address
8105 SHOAL CREEK BLVD, SUITE A, AUSTIN, TX 78757-8040
(512) 454-4641
(512) 454-1065
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2286TG
TX
152WC0802X
Corneal and Contact Management Optometrist
2286TG
TX
152WP0200X
Pediatric Optometrist
2286TG
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
81662Q
BCBS UPIN
TX
Enumeration date
06/22/2006
Last updated
03/04/2008
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