Mallard Eye Care, LLC

Primary specialty

OptometristTaxonomy code 152W00000X

Legal business name

MALLARD EYE CARE, LLC

Practice address

1224 Huntsville Hwy
Fayetteville, TN 37334-3618

Phone

(931) 433-0906

Fax

(615) 250-4911

NPI assigned

Sep 20, 2019

Organization subpart

No

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

Authorized official

Name

Dr. Christopher Mallard, OD

Title

Owner

Phone

(615) 302-4477

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Tax ID family

Mallard Eye Care LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Mallard Eye Care, LLC

  • Optometrist
  • Lewisburg, TN
  • NPI 1912516956
  NPD tax ID

Locations

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

{
    "created_epoch": "1568937600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1579737600000",
    "number": "1053962134",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4959 MAIN ST",
            "city": "SPRING HILL",
            "state": "TN",
            "postal_code": "371742727",
            "telephone_number": "615-302-4477",
            "fax_number": "615-250-4911"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1224 HUNTSVILLE HWY",
            "city": "FAYETTEVILLE",
            "state": "TN",
            "postal_code": "373343618",
            "telephone_number": "931-433-0906",
            "fax_number": "615-250-4911"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MALLARD EYE CARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-09-20",
        "last_updated": "2020-01-23",
        "certification_date": "2020-01-23",
        "status": "A",
        "authorized_official_last_name": "MALLARD",
        "authorized_official_first_name": "CHRISTOPHER",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "615-302-4477",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PENDING",
            "state": "TN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": ".",
            "affiliation": "N",
            "address_1": "1224 Huntsville Hwy",
            "city": "Fayetteville",
            "state": "TN",
            "country_code": "US",
            "postal_code": "373343618",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Beverly Booth Lowdermilk, LCSW
• Andrew Christopher Lyon, LMFT
• Amy Macmurdo-Broadhurst, B.A.
• Anne Macomber, MS
• Denisia Bernadette Maldonado, CERTIFIED SURGICAL A
• Olivia Mann
• Mary Martin, CNS
• Nicole Mathey, D.C.
• Sonya Lashun Mayes, B.S,
• Maylon Todd McAdams, DDS

• Optometrist in Fayetteville, TN
• Providers in Fayetteville, TN by specialty
• Optometrist in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2020; 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.