NPIMap

Organization Active NPI

Mallard Eye Care, LLC

  • Optometrist
  • Spring Hill, TN
National Provider Identifier
1255760286
Registry record updated Jan 23, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
2955 Issued in TN
Legal business name
MALLARD EYE CARE, LLC
Practice address
4959 Main St
Spring Hill, TN 37174-2727
Phone
(615) 302-4477
Fax
(615) 302-4485
NPI assigned
Nov 12, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 23, 2020

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

Authorized official

Name
Dr. Christopher Mallard, ODNPI 1255646907
Title
Owner
Phone
(615) 302-4477

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X 2955 TN Primary

Addresses

Primary practice location

4959 Main St
Spring Hill, TN 37174-2727

Mailing address

4959 Main St
Spring Hill, TN 37174-2727
Phone (615) 302-4477

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200117000432 TN Part B Supplier - Clinic/Group Practice 1759716806 Receives reassigned benefits from 4 practitioners
Practice locations: Columbia, TN; Spring Hill, TN

National Provider Directory

National Provider Directory
Tax ID family
Mallard Eye Care2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Locations

1224 Huntsville Hwy
Ofc
Fayetteville, TN 37334

4959 Main St
Ofc
Spring Hill, TN 37174

Practitioners & affiliated clinicians

Practitioners 4

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

NPI Registry JSON

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

{
    "created_epoch": "1384214400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1579737600000",
    "number": "1255760286",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4959 MAIN ST",
            "city": "SPRING HILL",
            "state": "TN",
            "postal_code": "371742727",
            "telephone_number": "615-302-4477",
            "fax_number": "615-302-4485"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4959 MAIN ST",
            "city": "SPRING HILL",
            "state": "TN",
            "postal_code": "371742727",
            "telephone_number": "615-302-4477",
            "fax_number": "615-302-4485"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MALLARD EYE CARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-11-12",
        "last_updated": "2020-01-23",
        "certification_date": "2020-01-23",
        "status": "A",
        "authorized_official_last_name": "MALLARD",
        "authorized_official_first_name": "CHRISTOPHER",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "615-302-4477",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "TN",
            "license": "2955",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Spring Hill, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.