Mockingbird Optical Shop LLC

Primary specialty

Customized Equipment (DME)Taxonomy code 332BC3200X

License

4487710001 Issued in TX

Legal business name

MOCKINGBIRD OPTICAL SHOP LLC

Practice address

5430 Fredericksburg Rd
Ste 100
San Antonio, TX 78229-3539

Phone

(210) 340-1212

Fax

(210) 525-9617

NPI assigned

May 23, 2005

Organization subpart

No

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

Authorized official

Name

Jay C. Collins

Title

Administrator

Phone

(210) 340-1212

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1116806400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1424995200000",
    "number": "1194728337",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5430 FREDERICKSBURG RD",
            "address_2": "SUITE 100",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782293539",
            "telephone_number": "210-340-1212",
            "fax_number": "210-525-9617"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5430 FREDERICKSBURG RD",
            "address_2": "STE 100",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782293539",
            "telephone_number": "210-340-1212",
            "fax_number": "210-525-9617"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOCKINGBIRD OPTICAL SHOP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-05-23",
        "last_updated": "2015-02-27",
        "status": "A",
        "authorized_official_last_name": "COLLINS",
        "authorized_official_first_name": "JAY",
        "authorized_official_middle_name": "C.",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "210-340-1212"
    },
    "taxonomies": [
        {
            "code": "332BC3200X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Customized Equipment",
            "state": "TX",
            "license": "4487710001",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Branden Mobley
• Savannah Mobley, LMT
• Shanpella M Mobley, DA
• Moc San Antonio II LLC
• Steffany Lea Mock, PA-C
• Marsha D Moczygemba, LVN
• Roger M Moczygemba, MD
• Rudolph Moczygemba, RRT
• Shelby Marie Moczygemba, PT, DPT
• Valerie J Moczygemba, LPC

• Customized Equipment (DME) in San Antonio, TX
• Providers in San Antonio, TX by specialty
• Customized Equipment (DME) in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.