Provider Demographics
NPI:1386815850
Name:ANN K. MCPHERRAN, O.D.
Entity Type:Organization
Organization Name:ANN K. MCPHERRAN, O.D.
Other - Org Name:PARADISE OPTOMETRY GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR OF OPTOMETRY
Authorized Official - Prefix:DR
Authorized Official - First Name:ANN
Authorized Official - Middle Name:K
Authorized Official - Last Name:MCPHERRAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:530-872-1376
Mailing Address - Street 1:PO BOX 886
Mailing Address - Street 2:
Mailing Address - City:PARADISE
Mailing Address - State:CA
Mailing Address - Zip Code:95967-0886
Mailing Address - Country:US
Mailing Address - Phone:530-872-1376
Mailing Address - Fax:530-872-3340
Practice Address - Street 1:5911 ALMOND ST
Practice Address - Street 2:
Practice Address - City:PARADISE
Practice Address - State:CA
Practice Address - Zip Code:95969-4508
Practice Address - Country:US
Practice Address - Phone:530-872-1376
Practice Address - Fax:530-872-3340
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-12
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT 9048 TPA152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0090480Medicaid
CA410019521OtherRAILROAD MEDICARE
CASD0090480Medicaid