1629539812 NPI number — CRAIG R MCNAMARA, OD PC

Table of content: (NPI 1629539812)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629539812 NPI number — CRAIG R MCNAMARA, OD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CRAIG R MCNAMARA, OD PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1629539812
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/01/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7613 HALCYON FOREST TRL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MONTGOMERY
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36117-3495
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
334-301-4990
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1717 S COLLEGE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AUBURN
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36832-5870
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-821-6943
Provider Business Practice Location Address Fax Number:
334-832-5870
Provider Enumeration Date:
03/29/2019

Additional Information

Authorized Official

Authorized Official Last Name:
MACLAUGHLIN
Authorized Official First Name:
VANCE
Authorized Official Middle Name:
Authorized Official Title or Position:
CRENDENTIALING
Authorized Official Telephone Number:
334-320-8440

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: S461TA293 . This is a "ALABAMA OPTOMETRIC ASSOCIATION" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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