Provider Demographics
NPI:1205280591
Name:BAILEY, TRAVIS WAYNE (OD)
Entity type:Individual
Prefix:DR
First Name:TRAVIS
Middle Name:WAYNE
Last Name:BAILEY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2007 S 1ST ST
Mailing Address - Street 2:STE 104
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-5195
Mailing Address - Country:US
Mailing Address - Phone:512-774-6002
Mailing Address - Fax:
Practice Address - Street 1:2007 S 1ST ST STE 104
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-5195
Practice Address - Country:US
Practice Address - Phone:512-774-6002
Practice Address - Fax:512-774-5975
Is Sole Proprietor?:No
Enumeration Date:2016-04-22
Last Update Date:2020-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8791T152WP0200X, 152WS0006X, 152W00000X, 152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152WS0006XEye and Vision Services ProvidersOptometristSports Vision
No152W00000XEye and Vision Services ProvidersOptometrist
No152WV0400XEye and Vision Services ProvidersOptometristVision Therapy