Southwest Eye Clinic, PLLC

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

208D00000X Issued in OK

Legal business name

SOUTHWEST EYE CLINIC, PLLC

Practice address

1240 SW 44TH St
Oklahoma City, OK 73109-3604

Phone

(405) 631-1527

Fax

(405) 631-9930

NPI assigned

Oct 18, 2006

Reactivated

Aug 6, 2024

Last updated

Aug 6, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. David B Mallory, MD

Title

Ceo/Manager

Phone

(405) 631-1527

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in OK

Enrollment records 1

Tax ID family

South West Eye Clinic2 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.

• Southwest Eye Clinic, PLLC

  • General Practice Physician
  • Oklahoma City, OK
  • NPI 1225083512
  NPD tax ID

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Pritesh Patel, O.D.

  • Optometrist
  • Oklahoma City, OK
  • NPI 1346693769
  Medicare reassignment NPD
• Kurt D Weir, MD

  • General Practice Physician
  • Oklahoma City, OK
  • NPI 1841200037
  Medicare reassignment

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

{
    "created_epoch": "1161129600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1722902400000",
    "number": "1386725224",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1240 SW 44TH ST",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731093604",
            "telephone_number": "405-631-1527",
            "fax_number": "405-631-9930"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1240 SW 44TH ST",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731093604",
            "telephone_number": "405-631-1527",
            "fax_number": "405-631-9930"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHWEST EYE CLINIC, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-18",
        "last_updated": "2024-08-06",
        "deactivation_date": "2024-07-11",
        "reactivation_date": "2024-08-06",
        "status": "A",
        "authorized_official_last_name": "MALLORY",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "CEO/MANAGER",
        "authorized_official_telephone_number": "405-631-1527",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "OK",
            "license": "208D00000X",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100059640A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Southwest Ambulatory Surgery Center, LLC
• Southwest Anesthesia Services, LLC
• Southwest Cardiology Associates, Inc.
• Southwest Chiropractic Center, Inc.
• Southwest Eye Clinic, PLLC
• Southwest Eye Institute, Inc. (ClearSight Center)
• Southwest Family Clinic
• Southwest Gastroenterology Associates PLLC
• Southwest General Surgery, PLLC
• Southwest LTC - NW Okc, LLC (Northwest Nursing Center)

• General Practice Physician in Oklahoma City, OK
• Providers in Oklahoma City, OK by specialty
• General Practice Physician in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2024; 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.