Leo W Mack Jr., M.D.

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

License

E4001 Issued in TX

Practice address

5791 New Copeland Rd
Tyler, TX 75703-3905

Phone

(903) 630-7007

Fax

(903) 630-7072

NPI assigned

Jan 30, 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

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Ophthalmology

Education

Loyola University of Chicago, Stritch School of Medicine, 1969

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

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.

• Leo W Mack Jr MD PA

  • Optometrist
  • Tyler, TX
  • NPI 1366619611
  Medicare reassignment NPD
• Frazier Vision, Incorporated

  • Optometrist
  • Tyler, TX
  • NPI 1417303272
  NPD (past)

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

{
    "created_epoch": "1138579200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1765238400000",
    "number": "1669443370",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5791 NEW COPELAND RD",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757033905",
            "telephone_number": "903-630-7007",
            "fax_number": "903-630-7072"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5791 NEW COPELAND RD",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757033905",
            "telephone_number": "903-630-7007",
            "fax_number": "903-630-7072"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MACK",
        "first_name": "LEO",
        "middle_name": "W",
        "name_suffix": "Jr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-30",
        "last_updated": "2025-12-09",
        "certification_date": "2025-12-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "TX",
            "license": "E4001",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "135428409",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sylvia A Macay, MD
• Jonathan Macclements, MD
• Douglas B Macha, MD
• Patricia D. Macha, MD
• Marissa Macias
• Samuel Andrew Mack, MD
• Brian Mackenzie
• Matt Mackler
• Brien M Macon, CRNA
• Dana Maddox

• Ophthalmology Physician in Tyler, TX
• Providers in Tyler, TX by specialty
• Ophthalmology Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2025; 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.