Provider Demographics
NPI:1154464717
Name:MCPHAILL, LARY KENNETH I (OD)
Entity Type:Individual
Prefix:
First Name:LARY
Middle Name:KENNETH
Last Name:MCPHAILL
Suffix:I
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3457 TEA ROSE DR
Mailing Address - Street 2:
Mailing Address - City:EL DORADO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:95762-6558
Mailing Address - Country:US
Mailing Address - Phone:530-672-2951
Mailing Address - Fax:
Practice Address - Street 1:2563 FAIR OAKS BLVD
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-7683
Practice Address - Country:US
Practice Address - Phone:916-480-9985
Practice Address - Fax:916-480-9987
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5740T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist