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General NPI Number Information
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NPI Number | 1366066466
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Entity Type | Organization
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Legal Business Name | MED SOUTHWEST, PLLC
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Dates
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Enumeration Date | 06/04/2020
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Last Update Date | 05/29/2022
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Provider Practice Location Address
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Address Line | 751 MID CITIES BLVD
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City | HURST
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State | TX
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Zip | 76054-2748
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Country | US
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Telephone | 817-656-2020
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Fax | 817-656-5908
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Provider Business Mailing Address
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Address Line | 8614 WESTWOOD CENTER DR FL 9
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City | VIENNA
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State | VA
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Zip | 22182-2442
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Country | US
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Telephone | 703-847-8899
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Fax | 571-223-6780
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Authorized Official
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Title or Position | SECRETARY
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Name | SUE DOWNES
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Credential |
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Telephone | 703-847-8899
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number |
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License Number State |
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