NPIMap

Organization Active NPI

Med Southwest, PLLC

  • Optometrist
  • Broken Bow, OK
National Provider Identifier
1174089478
Registry record updated May 29, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
MED SOUTHWEST, PLLC
Practice address
511 S Park Dr Ste a
Broken Bow, OK 74728-5329
Phone
(580) 584-3434
Fax
(580) 584-3454
NPI assigned
Feb 12, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 29, 2022

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

Authorized official

Name
Sue Downs
Title
Secretary
Phone
(703) 847-8899

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X Primary

Addresses

Primary practice location

511 S Park Dr Ste a
Broken Bow, OK 74728-5329

Mailing address

8614 Westwood Center Dr FL 9
Vienna, VA 22182-2442
Phone (703) 847-8899

Other names 1

  • MyEyeDr. Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20190411000911 OK Part B Supplier - Clinic/Group Practice 4082952874 Receives reassigned benefits from 43 practitioners
10 other NPIs on this enrollment
Practice locations: Tulsa, OK; Oklahoma City, OK; Idabel, OK; Edmond, OK; Broken Bow, OK; Broken Arrow, OK
O20211112000703 OK DME Supplier - Physician - Optometrist 4082952874 Practice locations: Broken Bow, OK

Other NPIs with the same Medicare PAC ID 15

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

View all 15

Other NPIs on the same Medicare enrollment 10

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
37D2301673Med Southwest, PLLC511 S Park Dr, Ste a, Broken Bow, OK 74728Certificate of waiverMar 28, 2028

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Med Southwest, PLLC511 S Park Dr, Broken Bow, OK 74728-5329(580) 584-3434 Prosthetic Lenses: Conventional Eyeglasses|Prosthetic Lenses: Conventional Contact Lenses Accepts assignmentParticipating since Feb 25, 2019

National Provider Directory

National Provider Directory
Tax ID family
Med Southwest PLLC154 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 13

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 13

Practitioners & affiliated clinicians

Practitioners 255

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 255

NPI Registry JSON

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

{
    "created_epoch": "1549929600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1653782400000",
    "number": "1174089478",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8614 WESTWOOD CENTER DR FL 9",
            "city": "VIENNA",
            "state": "VA",
            "postal_code": "221822442",
            "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": "511 S PARK DR STE A",
            "city": "BROKEN BOW",
            "state": "OK",
            "postal_code": "747285329",
            "telephone_number": "580-584-3434",
            "fax_number": "580-584-3454"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MED SOUTHWEST, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-02-12",
        "last_updated": "2022-05-29",
        "certification_date": "2022-05-29",
        "status": "A",
        "authorized_official_last_name": "DOWNS",
        "authorized_official_first_name": "SUE",
        "authorized_official_title_or_position": "SECRETARY",
        "authorized_official_telephone_number": "703-847-8899"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MyEyeDr.",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Broken Bow, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.