Individual provider Active NPI

Andrew Mario Archila, O.D.

  • Optometrist
  • Houston, TX
National Provider Identifier
1922087261
Registry record updated Aug 23, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
10187 Issued in TX
Practice address
4401 Martin Luther King Blvd
Houston, TX 77204-2020
Phone
(713) 743-2020
Fax
(713) 743-0963
NPI assigned
Jan 14, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 23, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X ODP-1007 ID
Optometrist 152W00000X 10187 TX Primary

Addresses

Primary practice location

4401 Martin Luther King Blvd
Houston, TX 77204-2020

Mailing address

4401 Martin Luther King Blve
Houston, TX 77204-2020
Phone (713) 743-2020

Other identifiers 1

IdentifierTypeStateIssuer
429529701MedicaidTX

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
I20210930003174 TX Practitioner - Optometry 1557442845 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
University of Houston - College of Optometry, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
University of Houston SystemGroup PAC ID 6901896356, 55 clinicians

Practice addresses (Care Compare)

190 Heights Blvd
Houston, TX 77007-3729
Phone (713) 527-8480

4401 Martin Luther King Blvd
Houston, TX 77204-2020
Phone (713) 743-2020

4849 Calhoun Rd
Suite 104
Houston, TX 77204-2020
Phone (713) 743-2020

4901 Calhoun Rd
Houston, TX 77204-2020
Phone (713) 743-2020

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
3074WIMDSocial Worker
10187TXMDChiropractor
ODP-1007IDMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
University of Houston System Optometrist CurrentSince Sep 1, 2021 Accepting new patients
University of Houston CurrentSince Sep 1, 2021 Accepting new patients
Stein Optical Inc. Optometrist Past Accepting new patients

Locations

190 Heights Blvd
Houston, TX 77007
Phone (713) 527-8480

4901 Calhoun Rd
Houston, TX 77204
Phone (713) 743-1921

4401 Martin Luther King Blvd
Houston, TX 77204
Phone (713) 743-1921

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": "1137196800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1661212800000",
    "number": "1922087261",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4401 MARTIN LUTHER KING BLVE",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "772042020",
            "telephone_number": "713-743-2020",
            "fax_number": "713-743-0963"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4401 MARTIN LUTHER KING BLVD",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "772042020",
            "telephone_number": "713-743-2020",
            "fax_number": "713-743-0963"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ARCHILA",
        "first_name": "ANDREW",
        "middle_name": "MARIO",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-14",
        "last_updated": "2022-08-23",
        "certification_date": "2022-08-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "ID",
            "license": "ODP-1007",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "TX",
            "license": "10187",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "429529701",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Houston, TX

Sources for this page

Verify at the official NPI Registry.