Provider Demographics
NPI:1699309773
Name:MODERN VISION GROUP, PLLC
Entity type:Organization
Organization Name:MODERN VISION GROUP, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:JUEL
Authorized Official - Last Name:BRINCHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:512-927-6947
Mailing Address - Street 1:3908 FAR W BLVD
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731
Mailing Address - Country:US
Mailing Address - Phone:512-343-0432
Mailing Address - Fax:512-583-0588
Practice Address - Street 1:3908 FAR W BLVD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731
Practice Address - Country:US
Practice Address - Phone:512-343-0432
Practice Address - Fax:512-583-0588
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-27
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty