MEDICARE: PHYSICIANS EYE CLINIC OF LAREDO

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	207W00000X	Ophthalmology Physician	Q7580	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1720305642	OTHER	TX	NPI INDIVIDUAL
2	1295311223	OTHER	TX	DR. MOTA NPI
3	Q7580	OTHER	TX	TX LICENSE

General Provider Information

NPI Number	:	1255853644
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHYSICIANS EYE CLINIC OF LAREDO

Provider Business Mailing Address
First Line	:	6999 MCPHERSON RD STE 216
Second Line	:
City	:	LAREDO
State	:	TX
Zip	:	78041-6450
Country	:	US
Telephone Number	:	956-401-6615
Fax Number	:	956-410-5304

Provider Business Practice Location Address
First Line	:	6999 MCPHERSON RD STE 216
Second Line	:
City	:	LAREDO
State	:	TX
Zip	:	78041-6450
Country	:	US
Telephone Number	:	956-401-6615
Fax Number	:	956-410-5304

Authorized Official
Title or Position	:	PRESIDENT
Name	:	STEPHEN A MCNUTT
Credential	:	M.D.
Telephone Number	:	443-695-3856

Provider Enumeration Date	:	07/07/2017
Last Update Date	:	12/14/2022

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Directions to “PHYSICIANS EYE CLINIC OF LAREDO ” Practice Location

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