Provider Demographics
NPI:1295822708
Name:MCHANEY, JOHN T (OD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:T
Last Name:MCHANEY
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 1:1014 W. MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:WALNUT RIDGE
Mailing Address - State:AR
Mailing Address - Zip Code:72476
Mailing Address - Country:US
Mailing Address - Phone:870-886-2632
Mailing Address - Fax:870-886-1514
Practice Address - Street 1:1014 W. MAIN ST
Practice Address - Street 2:
Practice Address - City:WALNUT RIDGE
Practice Address - State:AR
Practice Address - Zip Code:72476
Practice Address - Country:US
Practice Address - Phone:870-886-2632
Practice Address - Fax:870-886-1514
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2008-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2125152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR102555722Medicaid
AR48821Medicare PIN
AR0348860002Medicare NSC
ART20233Medicare UPIN