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Organization

ELITE EYE SPECIALISTS

Active
Parent organization
PROVISTA EYE CLINIC
Organization subpart
Yes

Provider details

NPI number
Legal business name
PROVISTA EYE CLINIC
Authorized official
DR. LINDA VARGAS MD (MD OWNER)
(512) 282-3937
Entity
Organization

Contact information

Practice address
11215 S IH 35, SUITE 102, AUSTIN, TX 78747-1863
(512) 282-3937
Mailing address
11215 S IH 35, SUITE 102, AUSTIN, TX 78747-1863
(512) 282-3937

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
62667G
TX
207W00000X
Ophthalmology Physician
Primary
L4779
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
3376983
AETNA
TX
Enumeration date
10/10/2006
Last updated
04/02/2008
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