Provider Demographics
NPI:1114919701
Name:MCMAHON, LOUIS MARTIN (OD)
Entity Type:Individual
Prefix:DR
First Name:LOUIS
Middle Name:MARTIN
Last Name:MCMAHON
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9513 VISCOUNT BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79925-7025
Mailing Address - Country:US
Mailing Address - Phone:915-590-9977
Mailing Address - Fax:915-590-9976
Practice Address - Street 1:9513 VISCOUNT BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79925-7025
Practice Address - Country:US
Practice Address - Phone:915-590-9977
Practice Address - Fax:915-590-9976
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3503TG152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0459141Medicaid
TX80718QOtherBLUE CROSS & BS
TX80718QOtherBLUE CROSS & BS
TX0459141Medicaid