Individual provider Active NPI

John Robert McGough, O.D.

  • Optometrist
  • Tyler, TX
National Provider Identifier
1780769802
Registry record updated Oct 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
3363 Issued in TX
Practice address
4524 S Broadway Ave
Tyler, TX 75703-1305
Phone
(903) 581-1530
Fax
(903) 534-8629
NPI assigned
Oct 26, 2006
Last updated
Oct 11, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 11, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 3363 TX Primary

Addresses

Primary practice location

4524 S Broadway Ave
Tyler, TX 75703-1305

Mailing address

8614 Westwood Center Dr FL 9
Vienna, VA 22182-2442
Phone (703) 847-8899

Other identifiers 2

IdentifierTypeStateIssuer
24068OtherTXOPTICARE CHIPS
80342QOtherTXBLUE CROSS

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
I20050324000894 TX Practitioner - Optometry 0345296364 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
University of Houston - College of Optometry, 1984
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Med Southwest PLLCGroup PAC ID 4082952874, 234 clinicians

Practice addresses (Care Compare)

2703 Richmond Rd
Texarkana, TX 75503-2328
Phone (903) 838-0783

4524 S Broadway Ave
Tyler, TX 75703-1305
Phone (903) 581-1530

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Med Southwest, PLLC Optometrist CurrentSince Oct 15, 2024 Accepting new patients
Med Southwest, PLLC Optometrist Current Accepting new patients
Med Southwest, PLLC Optometrist CurrentSince Oct 15, 2024 Accepting new patients
Silver Spring Optometry, LLC Optometrist Past Accepting new patients

Locations

6446 Lyndon B Johnson Fwy
Dallas, TX 75240
Phone (972) 960-2020

6127 FM 1960 Rd W
Houston, TX 77069
Phone (281) 469-2020

3032 N Eastman Rd
Ste 100
Longview, TX 75605
Phone (903) 663-2020

2703 Richmond Rd
Texarkana, TX 75503
Phone (903) 838-0783

4524 S Broadway Ave
Tyler, TX 75703
Phone (903) 581-1530

8329 Whitley Rd
Watauga, TX 76148
Phone (817) 431-2020

8614 Westwood Center Dr
Fl 9
Vienna, VA 22182

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1161820800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1728604800000",
    "number": "1780769802",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8614 WESTWOOD CENTER DR FL 9",
            "city": "VIENNA",
            "state": "VA",
            "postal_code": "221822442",
            "telephone_number": "703-847-8899",
            "fax_number": "571-223-6780"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4524 S BROADWAY AVE",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757031305",
            "telephone_number": "903-581-1530",
            "fax_number": "903-534-8629"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCGOUGH",
        "first_name": "JOHN",
        "middle_name": "ROBERT",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-26",
        "last_updated": "2024-10-11",
        "certification_date": "2024-10-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "TX",
            "license": "3363",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OPTICARE CHIPS",
            "identifier": "24068",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "80342Q",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tyler, TX

Sources for this page

Verify at the official NPI Registry.