Provider Demographics
NPI:1528006350
Name:MCDONALD, E F JR (OD)
Entity Type:Individual
Prefix:
First Name:E
Middle Name:F
Last Name:MCDONALD
Suffix:JR
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 1:430 W INDEPENDENCE ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MO
Mailing Address - Zip Code:63755-1203
Mailing Address - Country:US
Mailing Address - Phone:573-243-8732
Mailing Address - Fax:573-243-9620
Practice Address - Street 1:430 W INDEPENDENCE ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MO
Practice Address - Zip Code:63755-1203
Practice Address - Country:US
Practice Address - Phone:573-243-8732
Practice Address - Fax:573-243-9620
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-03
Last Update Date:2011-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOT02649152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO312159205Medicaid
MO312159205Medicaid
MO000006363Medicare UPIN
MOT42571Medicare UPIN
MOP00601098Medicare UPIN