Provider Demographics
NPI:1164465365
Name:MCCALLA-JACKSON, MARGARET S (OD)
Entity Type:Individual
Prefix:DR
First Name:MARGARET
Middle Name:S
Last Name:MCCALLA-JACKSON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9795 CROSSPOINT BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46256-3354
Mailing Address - Country:US
Mailing Address - Phone:317-254-6480
Mailing Address - Fax:317-259-8609
Practice Address - Street 1:2600 W 3RD ST
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47404-5227
Practice Address - Country:US
Practice Address - Phone:812-336-5432
Practice Address - Fax:812-332-5084
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2014-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18001887A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000078730OtherBLUE CROSS
IN100184230Medicaid
INT34661Medicare UPIN
IN411610007Medicare PIN