Mona Douglas, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

5038TG Issued in TX

Practice address

4524 S Broadway Ave
Tyler, TX 75703-1305

Phone

(903) 581-1530

Fax

(903) 534-8629

NPI assigned

Jun 19, 2013

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Mona Vicknair Former name

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

Specialty

Optometry

Education

University of Houston - College of Optometry, 1994

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Larry M Chism PC

  • Optometrist
  • Tyler, TX
  • NPI 1033247598
  Medicare reassignment NPD
• Med Southwest, PLLC

  • Optometrist
  • Houston, TX
  • NPI 1609348739
  Medicare reassignment NPD
• Med Southwest, PLLC

  • Optometrist
  • Houston, TX
  • NPI 1659033090
  NPD
• Med Southwest, PLLC

  • Optometrist
  • Oklahoma City, OK
  • NPI 1679440762
  NPD
• Complete Family Eyecare

  • Eyewear Supplier
  • Tyler, TX
  • NPI 1023270444
  NPD (past)

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

{
    "created_epoch": "1371600000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1371600000000",
    "number": "1962841387",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "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"
        },
        {
            "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": "DOUGLAS",
        "first_name": "MONA",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-06-19",
        "last_updated": "2013-06-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "TX",
            "license": "5038TG",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MONA",
            "last_name": "VICKNAIR",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Mallory Boteler Dougherty, M.S., CCC-SLP
• Lynsie Paige Doughten, FNP-C
• Jaye Doughtie, BCBA
• Douglas a. Witte, DDS, Ms, Inc.
• Drew Doran Douglas, O.D.
• Rick D Douglas, LCSW
• Tara Douglas
• Trevor Douglas
• Emma Dover, OTR
• Austin J Dowell, PHARMD

• Optometrist in Tyler, TX
• Providers in Tyler, TX by specialty
• Optometrist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.