Provider Demographics
NPI:1225340870
Name:WEIR, MACKENZIE (OD)
Entity Type:Individual
Prefix:DR
First Name:MACKENZIE
Middle Name:
Last Name:WEIR
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2921 I-40 W
Mailing Address - Street 2:SUITE 300
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79109-1616
Mailing Address - Country:US
Mailing Address - Phone:806-322-3937
Mailing Address - Fax:806-322-2220
Practice Address - Street 1:2921 I-40 W
Practice Address - Street 2:SUITE 300
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79109-1616
Practice Address - Country:US
Practice Address - Phone:806-322-3937
Practice Address - Fax:806-322-2220
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-12
Last Update Date:2012-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7589T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB165318OtherMEDICARE INDIVIDUAL PTAN