David F Mallavia, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

1379 Issued in AZ

Practice address

420 N Navajo Dr
Page, AZ 86040-0950

Phone

(928) 645-2772

Fax

(928) 645-9508

NPI assigned

Jul 6, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in AZ

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

Specialty

Optometry

Education

Southern California College of Optometry, 2004

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Interoperability endpoints

• FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

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.

• Mallavia OD PC

  • Optometrist
  • Page, AZ
  • NPI 1417169251

  AZ, Optometrist

  Medicare reassignment NPD Authorized official
• Retina Associates of Southern Utah

  • Ophthalmology Physician
  • St George, UT
  • NPI 1326307083
  NPD

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

{
    "created_epoch": "1152144000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1580774400000",
    "number": "1215969019",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1806",
            "city": "PAGE",
            "state": "AZ",
            "postal_code": "860401806",
            "telephone_number": "928-645-2772",
            "fax_number": "928-645-9508"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "420 N NAVAJO DR",
            "city": "PAGE",
            "state": "AZ",
            "postal_code": "860400950",
            "telephone_number": "928-645-2772",
            "fax_number": "928-645-9508"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MALLAVIA",
        "first_name": "DAVID",
        "middle_name": "F",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-06",
        "last_updated": "2020-02-04",
        "certification_date": "2020-02-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "AZ",
            "license": "1379",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• John W. Loosle, MSW
• Damian Loucks
• Dylan Vuduy Ly, PHARMD
• Ronald Grant Macdonald Jr., LPC, LISAC
• Mallavia OD PC
• Jeanie Manson, LISAC
• Theodore Martin
• Harold William Martindale, P.A.
• Clinton Charles McCormick, PHARM.D.
• Maria Dorothea McHenry, SLPA

• All providers in Page, AZ
• Optometrist in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.