Provider Demographics
NPI:1497842439
Name:ELITE EYE SPECIALISTS
Entity type:Organization
Organization Name:ELITE EYE SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:VARGAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-282-3937
Mailing Address - Street 1:11215 S IH 35
Mailing Address - Street 2:SUITE 102
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78747-1863
Mailing Address - Country:US
Mailing Address - Phone:512-282-3937
Mailing Address - Fax:
Practice Address - Street 1:11215 S IH 35
Practice Address - Street 2:SUITE 102
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78747-1863
Practice Address - Country:US
Practice Address - Phone:512-282-3937
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PROVISTA EYE CLINIC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-10
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX62667G152W00000X
TXL4779207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3376983OtherAETNA
TX3376983OtherAETNA
TXF05172Medicare UPIN