Provider Demographics
NPI:1497050603
Name:LOUIS M MCMAHON ODPA EYEWORLD
Entity type:Organization
Organization Name:LOUIS M MCMAHON ODPA EYEWORLD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:M
Authorized Official - Last Name:MCMAHON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:915-590-9977
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-19
Last Update Date:2018-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3503TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXT79048Medicare UPIN