Basic Information
| Provider Information | |||||||||
| NPI: | 1275782914 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | THE OPTOMETRY CENTER FOR VISION THERAPY CORP | ||||||||
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| OtherOrganizationName: | THE OPTOMETRY CENTER FOR VISION THERAPY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10601 PECAN PARK BLVD | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787501325 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5124010400 | ||||||||
| FaxNumber: | 5124010403 | ||||||||
| Practice Location | |||||||||
| Address1: | 10601 PECAN PARK BLVD | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787501325 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5124010400 | ||||||||
| FaxNumber: | 5124010403 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/18/2008 | ||||||||
| LastUpdateDate: | 12/12/2011 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | RIVERA | ||||||||
| AuthorizedOfficialFirstName: | BRIANA | ||||||||
| AuthorizedOfficialMiddleName: | MICHELLE | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 5124010400 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | O.D., FCOVD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 7197T | TX | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist | 152WV0400X | 7197T | TX | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist | Vision Therapy |
No ID Information.