NPIMap

Organization Active NPI

Austin Eye Clinic Association

Doing business as Austin Eye Laser and Surgicenter

  • Ambulatory Surgical Clinic/Center
  • Austin, TX
National Provider Identifier
1952398141
Registry record updated Sep 8, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
License
007153 Issued in TX
Legal business name
AUSTIN EYE CLINIC ASSOCIATION
Doing business as
Austin Eye Laser and Surgicenter
Practice address
11901 Jollyville Rd
Austin, TX 78759-2303
Phone
(512) 250-2020
Fax
(512) 250-2612
NPI assigned
Oct 3, 2005
Organization subpart
Yes
Parent organization
AUSTIN EYE CLINIC ASSOCIATIONAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 8, 2020

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

Authorized official

Name
Shannon M Wong, MDNPI 1497753040
Title
Ceo
Phone
(512) 250-2020

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X 007153 TX Primary

Addresses

Primary practice location

11901 Jollyville Rd
Austin, TX 78759-2303

Mailing address

11901 Jollyville Rd
Austin, TX 78759-2303
Phone (512) 250-2020

Other practice location 1

2700 Bee Caves Rd
Austin, TX 78746-5675
Phone (512) 250-2020

Other identifiers 1

IdentifierTypeStateIssuer
HH1529OtherTXBCBS TX

Other names 1

  • Austin Eye Laser and Surgicenter Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100408000168 TX Part B Supplier - Ambulatory Surgical Center 6608910542 Receives reassigned benefits from 1 practitioner
Practice locations: Austin, TX

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Care Compare: Ambulatory surgical center

Medicare Care Compare
Listed as
Austin Eye Laser and SurgicenterCCN 45C0001271
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory
Part of
Austin Eye Clinic Assn

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 13

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1128297600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1599523200000",
    "number": "1952398141",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11901 JOLLYVILLE RD",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787592303",
            "telephone_number": "512-250-2020",
            "fax_number": "512-250-2612"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11901 JOLLYVILLE RD",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787592303",
            "telephone_number": "512-250-2020",
            "fax_number": "512-250-2612"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2700 Bee Caves Rd",
            "address_purpose": "LOCATION",
            "city": "Austin",
            "state": "TX",
            "postal_code": "787465675",
            "country_code": "US",
            "telephone_number": "512-250-2020",
            "fax_number": "512-250-2612",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "AUSTIN EYE CLINIC ASSOCIATION",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "AUSTIN EYE CLINIC ASSOCIATION",
        "enumeration_date": "2005-10-03",
        "last_updated": "2020-09-08",
        "certification_date": "2020-09-08",
        "status": "A",
        "authorized_official_last_name": "WONG",
        "authorized_official_first_name": "SHANNON",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "512-250-2020",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "TX",
            "license": "007153",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS TX",
            "identifier": "HH1529",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Austin Eye Laser and Surgicenter",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Austin Eye Laser and Surgicenter",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Austin, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.