Individual provider Active NPI

Syndy Jane Maynard, O.D.

  • Optometrist
  • El Paso, TX
National Provider Identifier
1679906127
Registry record updated Aug 21, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
8256-T Issued in TX
Practice address
9473 Socorro Rd
El Paso, TX 79907-5619
Phone
(915) 858-1076
Fax
(915) 242-6562
NPI assigned
Aug 19, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 21, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 1647-681T LA
Optometrist 152W00000X 8256-T TX Primary

Addresses

Primary practice location

9473 Socorro Rd
El Paso, TX 79907-5619

Mailing address

9473 Socorro Rd
El Paso, TX 79907-5619
Phone (915) 858-1076

Other identifiers 1

IdentifierTypeStateIssuer
1679906127MedicaidTX

Medicare participation

Medicare enrollment files
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: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220804002628 TX Practitioner - Optometry 8224410436 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
University of Houston - College of Optometry, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ysleta del Sur Pueblo Community Health CenterGroup PAC ID 7517055015, 8 clinicians

Practice addresses (Care Compare)

9473 Socorro Rd
El Paso, TX 79907-5619
Phone (915) 858-1076

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
8256TXMDGeneral Practice Dentistry
1647-681TLAMDOptometrist
8256-TTXMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Ysleta del Sur Pueblo Community Health Center CurrentSince May 4, 2022 Accepting new patients
Daniel & Max Optometrist PastSince Feb 21, 2021 Accepting new patients

Locations

9314 Juanchido Ln
Ysleta del Sur Pueblo, TX 79907
Phone (915) 858-1076

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1376870400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1692576000000",
    "number": "1679906127",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9473 SOCORRO RD",
            "city": "EL PASO",
            "state": "TX",
            "postal_code": "799075619",
            "telephone_number": "915-858-1076",
            "fax_number": "915-242-6562"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9473 SOCORRO RD",
            "city": "EL PASO",
            "state": "TX",
            "postal_code": "799075619",
            "telephone_number": "915-858-1076",
            "fax_number": "915-242-6562"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAYNARD",
        "first_name": "SYNDY",
        "middle_name": "JANE",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-08-19",
        "last_updated": "2023-08-21",
        "certification_date": "2023-08-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "LA",
            "license": "1647-681T",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "TX",
            "license": "8256-T",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1679906127",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in El Paso, TX

Sources for this page

Verify at the official NPI Registry.