Brent L. Mixon, OD, LLC
Organization Active NPI Optometrist · Angleton, TX
NPI 1790953107 · NPPES record last updated Feb 19, 2008
Key facts
- NPI
- 1790953107
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Optometrist 152W00000X
- License
- 6944TG (TX)
- Legal business name
- BRENT L. MIXON, OD, LLC
- Practice address
- 1713 E Mulberry St
Angleton, TX 77515-3916 - Phone
- (979) 849-7321
- Fax
- (979) 849-7321
- NPI assigned
- Feb 19, 2008
- Organization subpart
- No
Authorized official
- Name
- Dr. Brent Lee Mixon, O.D.
- Title
- Owner
- Phone
- (979) 849-7321
Practitioners 2
-
Brent Lee Mixon, O.D.
-
Teresa Peck, O.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20080702000037 | TX | Part B Supplier - Clinic/Group Practice | 9234201534 |
Receives reassigned benefits from 1 practitioner Practice locations: Angleton, TX |
National Provider Directory
Locations
1713 E Mulberry St
Angleton, TX 77515
Phone (979) 849-7321
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist |
152W00000X | 6944TG | TX | Yes |
Addresses
Primary practice location
1713 E Mulberry St
Angleton, TX 77515-3916
Mailing address
1713 E Mulberry St
Angleton, TX 77515-3916
Phone (979) 849-7321
Other providers in Angleton, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 19, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.