Organization
PROVISTA EYE CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. LINDA VARGAS MD (MD OWNER)
(512) 326-5900
Entity
Organization
Contact information
Practice address
1109A E 6TH ST, AUSTIN, TX 78702-3210
(512) 326-5900
(512) 326-5988
Mailing address
1109A E 6TH ST, AUSTIN, TX 78702-3210
(512) 326-5900
(512) 326-5988
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0054KP
BLUE CROSS
TX
01
—
3376983
AETNA
TX
Enumeration date
10/10/2006
Last updated
04/02/2008
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