Med Southwest, PLLC
Organization Active NPI Optometrist · Watauga, TX
NPI 1104485945 · NPPES record last updated May 29, 2022
Key facts
- NPI
- 1104485945
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Optometrist 152W00000X
- Legal business name
- MED SOUTHWEST, PLLC
- Practice address
- 8329 Whitley Rd
Watauga, TX 76148-2483 - Phone
- (817) 431-2020
- NPI assigned
- Jun 6, 2019
- Organization subpart
- No
Authorized official
- Name
- Sue Downes
- Title
- Secretary
- Phone
- (703) 847-8899
Corporate family (same tax ID) 24
Practitioners 4
-
Shazia Karim, OD
-
Aaryn McComb, O.D.
-
George Morris Neel, O.D.
-
Tiffaney Tregellas, O. D.
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 45D2301532 | Med Southwest, PLLC | Certificate of waiver | Mar 26, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20190221001481 | TX | Part B Supplier - Clinic/Group Practice | 4082952874 |
Receives reassigned benefits from 379 practitioners This NPI is an additional NPI on the enrollment |
National Provider Directory
- Tax ID family
- Med Southwest PLLC
Locations
8329 Whitley Rd
Watauga, TX 76148
Phone (817) 431-2020
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist |
152W00000X | Yes |
Addresses
Primary practice location
8329 Whitley Rd
Watauga, TX 76148-2483
Mailing address
8614 Westwood Center Dr FL 9
Vienna, VA 22182-2442
Phone (703) 847-8899
Other names
- MyEyeDr.
Other providers in Watauga, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 29, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.