Provider Demographics
NPI:1982779104
Name:FINE EYEWEAR
Entity type:Organization
Organization Name:FINE EYEWEAR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:VANESSA
Authorized Official - Middle Name:TRAN
Authorized Official - Last Name:MINNICK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:512-260-9779
Mailing Address - Street 1:2800 E WHITESTONE BLVD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-7273
Mailing Address - Country:US
Mailing Address - Phone:512-260-9779
Mailing Address - Fax:512-260-3703
Practice Address - Street 1:2800 E WHITESTONE BLVD
Practice Address - Street 2:SUITE 210
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-7273
Practice Address - Country:US
Practice Address - Phone:512-260-9779
Practice Address - Fax:512-260-3703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2011-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00922VMedicare PIN