Provider Demographics
NPI:1144231309
Name:MCDONALD, GEORGE ARTHUR (OD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:ARTHUR
Last Name:MCDONALD
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 1:102 N FREEMAN AVE
Mailing Address - Street 2:
Mailing Address - City:LUVERNE
Mailing Address - State:MN
Mailing Address - Zip Code:56156-1628
Mailing Address - Country:US
Mailing Address - Phone:507-283-2345
Mailing Address - Fax:507-283-2346
Practice Address - Street 1:102 N FREEMAN AVE
Practice Address - Street 2:
Practice Address - City:LUVERNE
Practice Address - State:MN
Practice Address - Zip Code:56156-1628
Practice Address - Country:US
Practice Address - Phone:507-283-2345
Practice Address - Fax:507-283-2346
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1470152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN66D19OtherBLUE CROSS BLUE SHIELD
MNT70789Medicare UPIN