Individual provider Active NPI

Marcus Aaron Whatley, O.D.

  • Optometrist
  • Southlake, TX
National Provider Identifier
1144450693
Registry record updated Mar 6, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
7464TG Issued in TX
Practice address
1247 Main St
Southlake, TX 76092-7603
Phone
(817) 481-2070
Fax
(817) 410-9277
NPI assigned
Jul 17, 2009
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 6, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 7464TG TX Primary

Addresses

Primary practice location

1247 Main St
Southlake, TX 76092-7603

Mailing address

1247 Main St
Southlake, TX 76092-7603
Phone (817) 481-2070

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
I20100816000365 TX Practitioner - Optometry 9537293303 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
University of Houston - College of Optometry, 2009
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)

1534 E Southlake Blvd
Southlake, TX 76092-6421
Phone (817) 481-2070

Procedures performed for Medicare patients

ProcedureNumber of procedures
Cataract surgery1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
7464TGTXMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Med Southwest, PLLC Optometrist Current Accepting new patients
Med Southwest, PLLC Optometrist CurrentSince Oct 23, 2019 Accepting new patients
Med Southwest, PLLC Optometrist CurrentSince Oct 23, 2019 Accepting new patients
Silver Spring Optometry, LLC Optometrist Past Accepting new patients

Locations

3000 S Hulen St
Ft Worth, TX 76109
Phone (817) 570-2960

1534 E Southlake Blvd
Southlake, TX 76092
Phone (817) 481-2070

1247 Main St
Southlake, TX 76092
Phone (817) 481-2070

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

8329 Whitley Rd
Watauga, TX 76148
Phone (817) 431-2020

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": "1247788800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1267833600000",
    "number": "1144450693",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1247 MAIN ST",
            "city": "SOUTHLAKE",
            "state": "TX",
            "postal_code": "760927603",
            "telephone_number": "817-481-2070",
            "fax_number": "817-410-9277"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1247 MAIN ST",
            "city": "SOUTHLAKE",
            "state": "TX",
            "postal_code": "760927603",
            "telephone_number": "817-481-2070",
            "fax_number": "817-410-9277"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WHATLEY",
        "first_name": "MARCUS",
        "middle_name": "AARON",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-07-17",
        "last_updated": "2010-03-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "TX",
            "license": "7464TG",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Southlake, TX

Sources for this page

Verify at the official NPI Registry.