Provider Demographics
NPI:1134793987
Name:EYES OF CEDAR PARK
Entity type:Organization
Organization Name:EYES OF CEDAR PARK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:EUGENIO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:512-260-8686
Mailing Address - Street 1:1118 ANTELOPE RDG
Mailing Address - Street 2:
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-3237
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1101 C-BAR RANCH TRL LOT 2
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-7595
Practice Address - Country:US
Practice Address - Phone:512-260-8686
Practice Address - Fax:512-949-5120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-17
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty