Individual provider Active NPI

Maury I Diskin, O.D.

  • Optometrist
  • San Antonio, TX
National Provider Identifier
1104007517
Registry record updated Oct 29, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
6740T Issued in TX
Practice address
255 E Basse Rd Ste 330
San Antonio, TX 78209-8343
Phone
(210) 308-8565
Fax
(210) 525-8317
NPI assigned
Nov 14, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 29, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 6740T TX Primary

Addresses

Primary practice location

255 E Basse Rd Ste 330
San Antonio, TX 78209-8343

Mailing address

1950 Old Gallows Rd Ste 520
Vienna, VA 22182-3970
Phone (703) 847-8899

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110926000178 TX Practitioner - Optometry 1355512294 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Other, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Med Southwest PLLCGroup PAC ID 4082952874, 234 clinicians

Practice addresses (Care Compare)

255 E Basse Rd
Suite 330
San Antonio, TX 78209-8343
Phone (210) 308-8565

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
6740TTXMDOptometrist
6740TXMDAthletic Trainer

Practice roles

OrganizationSpecialtyStatusNew patients
Med Southwest, PLLC Optometrist Current Accepting new patients
Med Southwest, PLLC Optometrist CurrentSince Aug 3, 2020 Accepting new patients
Med Southwest, PLLC Optometrist CurrentSince Aug 3, 2020 Accepting new patients
Silver Spring Optometry, LLC Optometrist Past Accepting new patients

Locations

255 E Basse Rd
Ste 330
San Antonio, TX 78209
Phone (210) 308-8565

2703 Richmond Rd
Texarkana, TX 75503
Phone (903) 838-0783

8614 Westwood Center Dr
Fl 9
Vienna, VA 22182

1950 Old Gallows Rd
Ste 520
Vienna, VA 22182

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1194998400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1635465600000",
    "number": "1104007517",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1950 OLD GALLOWS RD STE 520",
            "city": "VIENNA",
            "state": "VA",
            "postal_code": "221823970",
            "telephone_number": "703-847-8899",
            "fax_number": "571-223-6780"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "255 E BASSE RD STE 330",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782098343",
            "telephone_number": "210-308-8565",
            "fax_number": "210-525-8317"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DISKIN",
        "first_name": "MAURY",
        "middle_name": "I",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-11-14",
        "last_updated": "2021-10-29",
        "certification_date": "2021-10-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "TX",
            "license": "6740T",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Antonio, TX

Sources for this page

Verify at the official NPI Registry.