Organization
LAKELINE EYE CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SEAN FULLER O.D. (PRESIDENT)
(512) 401-6000
Entity
Organization
Contact information
Practice address
11200 LAKELINE MALL DR, ST. E-5, CEDAR PARK, TX 78613-1501
(512) 401-6000
(512) 401-6004
Mailing address
11200 LAKELINE MALL DR, ST. E-5, CEDAR PARK, TX 78613-1501
(512) 401-6000
(512) 401-6004
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
6531TG
TX
Other
Enumeration date
11/02/2010
Last updated
11/02/2010
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