MEDICARE: DR. MACKENZIE WEIR O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	7589T	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	TXB165318	OTHER	TX	MEDICARE INDIVIDUAL PTAN

General Provider Information

NPI Number	:	1225340870
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MACKENZIE WEIR O.D.

Provider Business Mailing Address
First Line	:	2921 I-40 W
Second Line	:	SUITE 300
City	:	AMARILLO
State	:	TX
Zip	:	79109-1616
Country	:	US
Telephone Number	:	806-322-3937
Fax Number	:	806-322-2220

Provider Business Practice Location Address
First Line	:	2921 I-40 W
Second Line	:	SUITE 300
City	:	AMARILLO
State	:	TX
Zip	:	79109-1616
Country	:	US
Telephone Number	:	806-322-3937
Fax Number	:	806-322-2220

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/12/2010
Last Update Date	:	12/09/2025

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Directions to “ DR. MACKENZIE WEIR O.D.” Practice Location

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