Provider Demographics
NPI:1316951056
Name:EVANS, PAMELA (OD)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:EVANS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:
Other - Last Name:EVANS-BERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:311 RIVER BEND DR
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78628-2782
Mailing Address - Country:US
Mailing Address - Phone:512-931-2255
Mailing Address - Fax:
Practice Address - Street 1:311 RIVER BEND DR
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78628-2782
Practice Address - Country:US
Practice Address - Phone:512-931-2255
Practice Address - Fax:512-819-9528
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX04076T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXT04076Medicare UPIN
TX8F1722Medicare ID - Type Unspecified