Mallard Eyecare, Inc

Primary specialty

OptometristTaxonomy code 152W00000X

Legal business name

MALLARD EYECARE, INC

Practice address

1415 7TH St S
Clanton, AL 35045-3746

Phone

(205) 755-7114

NPI assigned

May 26, 2010

Last updated

May 26, 2010By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Bonnie Mallard, O.D.NPI 1407849318

Title

President

Phone

(205) 755-7114

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in AL

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Bonnie E Mallard, OD

  • Optometrist
  • Clanton, AL
  • NPI 1407849318
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1274832000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1274832000000",
    "number": "1942529292",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "826 SAVANNAH LN",
            "city": "CALERA",
            "state": "AL",
            "postal_code": "350405553"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1415 7TH ST S",
            "city": "CLANTON",
            "state": "AL",
            "postal_code": "350453746",
            "telephone_number": "205-755-7114"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MALLARD EYECARE, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-05-26",
        "last_updated": "2010-05-26",
        "status": "A",
        "authorized_official_last_name": "MALLARD",
        "authorized_official_first_name": "BONNIE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "205-755-7114",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "009933443",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lauren Moran Lovett, DPT
• Lia Farris Lovoy
• Dara S Lowery, RPT
• Bethany Baker Lyn, O.D.
• Maurice Jose Lyn, O.D.
• Bonnie E Mallard, OD
• Leslie Brett Markham
• Donna Marsh, LPC
• Matthew J. McCain DMD, LLC
• Leshunn Renee McLeod, LPC

• Optometrist in Clanton, AL
• Providers in Clanton, AL by specialty
• Optometrist in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 26, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.