Mack, Leo W

Mack, Leo W is an individual health care provider with primary practice located at 5791 New Copeland Rd , Tyler TX 75703-3905. He recently has only one registered license in Allopathic & Osteopathic Physicians / Ophthalmology, which is considered as his primary health care specialty. Mack, Leo W can be contacted via phone (903) 630-7007.

Contact Information

Primary practice address
5791 New Copeland Rd Tyler TX 75703-3905
Phone: (903) 630-7007
Fax: (903) 630-7072
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Ophthalmology 207W00000X E4001 Texas

Profile Details

NPI number 1669443370
LBN Legal business name Mack, Leo W
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 30th, 2006
Last updated Apr 25th, 2022 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1669443370 NPPES
Texas MEDICAID 135428409

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