Provider Demographics
NPI:1891151775
Name:DRIPPING SPRINGS OPHTHALMOLOGY ASSOCIATES PLLC
Entity type:Organization
Organization Name:DRIPPING SPRINGS OPHTHALMOLOGY ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LARA
Authorized Official - Middle Name:T
Authorized Official - Last Name:DUDEK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-213-2220
Mailing Address - Street 1:13830 SAWYER RANCH ROAD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:DRIPPING SPRINGS
Mailing Address - State:TX
Mailing Address - Zip Code:78620-5246
Mailing Address - Country:US
Mailing Address - Phone:512-213-2220
Mailing Address - Fax:512-213-2237
Practice Address - Street 1:13830 SAWYER RANCH ROAD
Practice Address - Street 2:SUITE 202
Practice Address - City:DRIPPING SPRINGS
Practice Address - State:TX
Practice Address - Zip Code:78620-5246
Practice Address - Country:US
Practice Address - Phone:512-213-2220
Practice Address - Fax:512-213-2237
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-08
Last Update Date:2017-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3547887Medicaid
TX473721Medicare PIN