Provider Demographics
NPI:1962600130
Name:NORTH AUSTIN OPTICAL
Entity type:Organization
Organization Name:NORTH AUSTIN OPTICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:MYRON
Authorized Official - Middle Name:D
Authorized Official - Last Name:RIGG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-458-4440
Mailing Address - Street 1:8015 SHOAL CREEK BLVD
Mailing Address - Street 2:SUITE 123
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78757-8066
Mailing Address - Country:US
Mailing Address - Phone:512-458-4440
Mailing Address - Fax:
Practice Address - Street 1:8015 SHOAL CREEK BLVD
Practice Address - Street 2:SUITE 123
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78757-8066
Practice Address - Country:US
Practice Address - Phone:512-458-4440
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-10
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
0914310001Medicare NSC