Provider Demographics
NPI:1073513636
Name:MCCONNELL, WILLIAM HALL (OD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:HALL
Last Name:MCCONNELL
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 37
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:TN
Mailing Address - Zip Code:38320
Mailing Address - Country:US
Mailing Address - Phone:731-584-6161
Mailing Address - Fax:731-584-6606
Practice Address - Street 1:194 W. MAIN ST.
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:TN
Practice Address - Zip Code:38320
Practice Address - Country:US
Practice Address - Phone:731-584-6161
Practice Address - Fax:731-584-6606
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNTN-545152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3593105Medicaid
TN3593105Medicaid
3593105Medicare ID - Type Unspecified