Provider Demographics
NPI:1356851430
Name:MCKELL, JAMES DOUGLAS (OD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:DOUGLAS
Last Name:MCKELL
Suffix:
Gender:M
Credentials:OD
Other - Prefix:DR
Other - First Name:J.D.
Other - Middle Name:
Other - Last Name:MCKELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:62 E 100 S
Mailing Address - Street 2:
Mailing Address - City:AMERICAN FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84003-2322
Mailing Address - Country:US
Mailing Address - Phone:801-494-7146
Mailing Address - Fax:
Practice Address - Street 1:228 E 6400 S
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-7305
Practice Address - Country:US
Practice Address - Phone:801-263-9125
Practice Address - Fax:801-269-1339
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-03
Last Update Date:2020-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10391412-9934152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist