NPIMap

Organization Active NPI

Complete Family Eyecare

  • Optometrist
  • Tyler, TX
National Provider Identifier
1083706352
Registry record updated Jun 23, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
3363TG Issued in TX
Legal business name
COMPLETE FAMILY EYECARE
Practice address
510 SSW Loop 323
Tyler, TX 75702
Phone
(903) 593-2109
Fax
(903) 593-4799
NPI assigned
Sep 28, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 23, 2008

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

Authorized official

Name
Dr. John Robert McGough, OD
Title
Optometrist
Phone
(903) 593-2109

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 152W00000X 3363TG TX Primary
OptometristGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 152W00000X LA962 LA

Addresses

Primary practice location

510 SSW Loop 323
Tyler, TX 75702

Mailing address

510 SSW Loop 323
Tyler, TX 75702
Phone (903) 593-2109

Other identifiers 1

IdentifierTypeStateIssuer
019857401MedicaidTX

Other names 1

  • East Texas Vision Center Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Complete Family Eyecare2 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.

Locations

510 Ssw Loop 323
Tyler, TX 75702
Phone (903) 530-0240

NPI Registry JSON

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

{
    "created_epoch": "1159401600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1214179200000",
    "number": "1083706352",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "510 SSW LOOP 323",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "75702",
            "telephone_number": "903-593-2109",
            "fax_number": "903-593-4799"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "510 SSW LOOP 323",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "75702",
            "telephone_number": "903-593-2109",
            "fax_number": "903-593-4799"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMPLETE FAMILY EYECARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-28",
        "last_updated": "2008-06-23",
        "status": "A",
        "authorized_official_last_name": "MCGOUGH",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "ROBERT",
        "authorized_official_title_or_position": "OPTOMETRIST",
        "authorized_official_telephone_number": "903-593-2109",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "TX",
            "license": "3363TG",
            "primary": true
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "LA",
            "license": "LA962",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "019857401",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "East Texas Vision Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Tyler, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2008; 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.