NPIMap

Med Southwest, PLLC

Organization Active NPI Optometrist · Richardson, TX

NPI 1194368407 · NPPES record last updated May 29, 2022

Key facts

NPI
1194368407
Entity type
Organization (NPI type 2)
Primary specialty
Optometrist 152W00000X
Legal business name
MED SOUTHWEST, PLLC
Practice address
1090 W Campbell Rd Ste 100
Richardson, TX 75080-2993
Phone
(972) 237-9595
Fax
(972) 468-8388
NPI assigned
Oct 21, 2019
Organization subpart
No

Authorized official

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

Corporate family (same tax ID) 24

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners 2

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

Medicare participation

Medicare fee-for-service enrollment
Enrolled in TX

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
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 (154 organizations share this tax ID)

Locations

1090 W Campbell Rd
Ste 100
Richardson, TX 75080
Phone (972) 231-9595

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist
Group: 193400000X SINGLE SPECIALTY GROUP		 152W00000X Yes

Addresses

Primary practice location

1090 W Campbell Rd Ste 100
Richardson, TX 75080-2993

Mailing address

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

Other names

  • MyEyeDr. Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on May 29, 2022.

{
    "created_epoch": "1571616000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1653782400000",
    "number": "1194368407",
    "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": "1090 W CAMPBELL RD STE 100",
            "city": "RICHARDSON",
            "state": "TX",
            "postal_code": "750802993",
            "telephone_number": "972-237-9595",
            "fax_number": "972-468-8388"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MED SOUTHWEST, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-10-21",
        "last_updated": "2022-05-29",
        "certification_date": "2022-05-29",
        "status": "A",
        "authorized_official_last_name": "DOWNES",
        "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 Richardson, TX

All providers in Richardson, TX · Optometrist in Texas

Sources for this page

Verify at the official NPI Registry.