NPIMap

Organization Active NPI

Lakeline Eye Center

  • Optometrist
  • Cedar Park, TX
National Provider Identifier
1285934539
Registry record updated Nov 2, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
6531TG Issued in TX
Legal business name
LAKELINE EYE CENTER
Practice address
11200 Lakeline Mall Dr
St. E-5
Cedar Park, TX 78613-1501
Phone
(512) 401-6000
Fax
(512) 401-6004
NPI assigned
Nov 2, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 2, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Sean Fuller, O.D.
Title
President
Phone
(512) 401-6000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X 6531TG TX Primary

Addresses

Primary practice location

11200 Lakeline Mall Dr
St. E-5
Cedar Park, TX 78613-1501

Mailing address

11200 Lakeline Mall Dr
St. E-5
Cedar Park, TX 78613-1501
Phone (512) 401-6000

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1288656000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1288656000000",
    "number": "1285934539",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11200 LAKELINE MALL DR",
            "address_2": "ST. E-5",
            "city": "CEDAR PARK",
            "state": "TX",
            "postal_code": "786131501",
            "telephone_number": "512-401-6000",
            "fax_number": "512-401-6004"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11200 LAKELINE MALL DR",
            "address_2": "ST. E-5",
            "city": "CEDAR PARK",
            "state": "TX",
            "postal_code": "786131501",
            "telephone_number": "512-401-6000",
            "fax_number": "512-401-6004"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKELINE EYE CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-11-02",
        "last_updated": "2010-11-02",
        "status": "A",
        "authorized_official_last_name": "FULLER",
        "authorized_official_first_name": "SEAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "512-401-6000",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "TX",
            "license": "6531TG",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cedar Park, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.