=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972761856
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EYE WORLD
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/28/2008
-----------------------------------------------------
Last Update Date | 05/28/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9513 VISCOUNT BLVD SUITE B
-----------------------------------------------------
City | EL PASO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79925-7025
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 915-590-9977
-----------------------------------------------------
Fax | 915-590-9976
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9513 VISCOUNT BLVD SUITE B
-----------------------------------------------------
City | EL PASO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79925-7025
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 915-590-9977
-----------------------------------------------------
Fax | 915-590-9976
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. LOUIS MARTIN MCMAHON
-----------------------------------------------------
Credential | O.D.
-----------------------------------------------------
Telephone | 915-590-9977
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152WC0802X
-----------------------------------------------------
Taxonomy Name | Corneal and Contact Management Optometrist
-----------------------------------------------------
License Number | 3503TG
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------