Provider Demographics
NPI:1467410209
Name:MCNEAL, JIMMY CHRISTOPHER (OD)
Entity Type:Individual
Prefix:DR
First Name:JIMMY
Middle Name:CHRISTOPHER
Last Name:MCNEAL
Suffix:
Gender:M
Credentials:OD
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Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:301 ANDREWS AVE
Mailing Address - Street 2:LYSTER ARMY HEALTH CLINIC - EENT
Mailing Address - City:FORT RUCKER
Mailing Address - State:AL
Mailing Address - Zip Code:36362-5333
Mailing Address - Country:US
Mailing Address - Phone:334-255-7185
Mailing Address - Fax:334-255-7183
Practice Address - Street 1:301 ANDREWS AVE
Practice Address - Street 2:LYSTER ARMY HEALTH CLINIC - EENT
Practice Address - City:FORT RUCKER
Practice Address - State:AL
Practice Address - Zip Code:36362-5333
Practice Address - Country:US
Practice Address - Phone:334-255-7185
Practice Address - Fax:334-255-7183
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS-A05-TA-579152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U91072Medicare UPIN