Provider Demographics
NPI:1396932232
Name:AUSTIN OCULAR PROSTHETICS CENTER LLC
Entity type:Organization
Organization Name:AUSTIN OCULAR PROSTHETICS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD CERTIFIED OCULARIST
Authorized Official - Prefix:MR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:R
Authorized Official - Last Name:PATAKY
Authorized Official - Suffix:
Authorized Official - Credentials:BCO
Authorized Official - Phone:512-452-3100
Mailing Address - Street 1:711 W 38TH ST
Mailing Address - Street 2:STE G1A
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705-1121
Mailing Address - Country:US
Mailing Address - Phone:512-452-3100
Mailing Address - Fax:512-452-3200
Practice Address - Street 1:711 W 38TH ST
Practice Address - Street 2:STE G1A
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-1121
Practice Address - Country:US
Practice Address - Phone:512-452-3100
Practice Address - Fax:512-452-3200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-25
Last Update Date:2011-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1700XEye and Vision Services ProvidersTechnician/TechnologistOcularistGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX195117001Medicaid
TX532747OtherBLUECROSS BLUESHIELD OF TEXAS
TX195117001Medicaid