Provider Demographics
NPI:1255500849
Name:MCCONNELL VISION CENTER
Entity Type:Organization
Organization Name:MCCONNELL VISION CENTER
Other - Org Name:WILLIAM H. MCCONNELL, O.D.
Other - Org Type:Other Name
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:H
Authorized Official - Last Name:MCCONNELL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:731-584-6161
Mailing Address - Street 1:PO BOX 37
Mailing Address - Street 2:194 WEST MAIN STREET
Mailing Address - City:CAMDEN
Mailing Address - State:TN
Mailing Address - Zip Code:38320-0037
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:38320-1609
Practice Address - Country:US
Practice Address - Phone:731-584-6161
Practice Address - Fax:731-584-6606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-27
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN545302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0282510001Medicare NSC