Provider Demographics
NPI:1699052407
Name:AMARILLO FAMILY EYECARE, PC
Entity type:Organization
Organization Name:AMARILLO FAMILY EYECARE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MACKENZIE
Authorized Official - Middle Name:HILL
Authorized Official - Last Name:WEIR
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:806-322-3937
Mailing Address - Street 1:2921 I-40 W
Mailing Address - Street 2:SUITE 300
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79109-1616
Mailing Address - Country:US
Mailing Address - Phone:806-322-3937
Mailing Address - Fax:806-322-2220
Practice Address - Street 1:2921 I-40 W
Practice Address - Street 2:SUITE 300
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79109-1616
Practice Address - Country:US
Practice Address - Phone:806-322-3937
Practice Address - Fax:806-322-2220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-08
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB165317OtherMEDICARE GROUP PTAN