Provider Demographics
NPI:1245413384
Name:MJC VISION
Entity Type:Organization
Organization Name:MJC VISION
Other - Org Name:SOUTHWEST VISION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIO
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:CONTALDI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:817-281-3386
Mailing Address - Street 1:7728 MID CITIES BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTH RICHLAND HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:76180-4621
Mailing Address - Country:US
Mailing Address - Phone:817-281-3386
Mailing Address - Fax:817-281-9287
Practice Address - Street 1:7728 MID CITIES BLVD
Practice Address - Street 2:
Practice Address - City:NORTH RICHLAND HILLS
Practice Address - State:TX
Practice Address - Zip Code:76180-4621
Practice Address - Country:US
Practice Address - Phone:817-281-3386
Practice Address - Fax:817-281-9287
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-12
Last Update Date:2008-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX03329TG152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX191450902Medicaid
TX8B8229Medicare PIN