Provider Demographics
NPI:1285671271
Name:GLAUCOMA INSTITUTE OF AUSTIN PA
Entity type:Organization
Organization Name:GLAUCOMA INSTITUTE OF AUSTIN PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:
Authorized Official - Last Name:HAYHURST
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-452-8467
Mailing Address - Street 1:901 W 38TH ST
Mailing Address - Street 2:STE 303
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705-1163
Mailing Address - Country:US
Mailing Address - Phone:512-452-8467
Mailing Address - Fax:512-452-8440
Practice Address - Street 1:901 W 38TH ST
Practice Address - Street 2:STE 303
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-1163
Practice Address - Country:US
Practice Address - Phone:512-452-8467
Practice Address - Fax:512-452-8440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-31
Last Update Date:2011-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00310UMedicare PIN
F82373Medicare UPIN