Individual provider Active NPI

Tanya Thuruthuvelil, OD

  • Optometrist
  • Forney, TX
National Provider Identifier
1902585094
Registry record updated Aug 8, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
10980 Issued in TX
Practice address
104 E US Highway 80 Ste 100
Forney, TX 75126-8616
Phone
(972) 552-2020
NPI assigned
Jul 14, 2023
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 8, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 10980 TX Primary

Addresses

Primary practice location

104 E US Highway 80 Ste 100
Forney, TX 75126-8616

Mailing address

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

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
I20231025001007 TX Practitioner - Optometry 5092161232 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Other, 2021
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)

104 E US Hwy 80
Suite 100
Forney, TX 75126-8616
Phone (972) 552-2020

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

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
10980TXMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Med Southwest, PLLC Optometrist Current Accepting new patients
Med Southwest, PLLC Optometrist CurrentSince Aug 8, 2023 Accepting new patients
Med Southwest, PLLC Optometrist CurrentSince Aug 8, 2023 Accepting new patients

Locations

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

104 E US Highway 80
Ste 100
Forney, TX 75126
Phone (972) 552-2020

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

8614 Westwood Center Dr
Fl 9
Vienna, VA 22182

Organizations & group practices 3

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": "1689292800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1691452800000",
    "number": "1902585094",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "104 E US HIGHWAY 80 STE 100",
            "city": "FORNEY",
            "state": "TX",
            "postal_code": "751268616",
            "telephone_number": "972-552-2020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THURUTHUVELIL",
        "first_name": "TANYA",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-07-14",
        "last_updated": "2023-08-08",
        "certification_date": "2023-08-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "TX",
            "license": "10980",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Forney, TX

Sources for this page

Verify at the official NPI Registry.