Provider Demographics
NPI:1528201464
Name:THOMAS TERRELL MCGINN JR OD LLC
Entity Type:Organization
Organization Name:THOMAS TERRELL MCGINN JR OD LLC
Other - Org Name:LOW VISION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:TERRELL
Authorized Official - Last Name:MCGINN
Authorized Official - Suffix:JR
Authorized Official - Credentials:OD
Authorized Official - Phone:985-626-9995
Mailing Address - Street 1:550 EVERGREEN DRIVE
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70448
Mailing Address - Country:US
Mailing Address - Phone:985-626-9995
Mailing Address - Fax:985-626-9995
Practice Address - Street 1:4324 VETERANS MEMORIAL BLVD.
Practice Address - Street 2:SUITE 104
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006
Practice Address - Country:US
Practice Address - Phone:504-455-7619
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-08
Last Update Date:2009-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LALA 1090-105T152WL0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WL0500XEye and Vision Services ProvidersOptometristLow Vision RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA49789Medicare UPIN