Provider Demographics
NPI:1609979491
Name:MCDONALD, JOYCE ANDERSON (OD)
Entity Type:Individual
Prefix:
First Name:JOYCE
Middle Name:ANDERSON
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5315 N CENTRAL EXPY
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75205-3319
Mailing Address - Country:US
Mailing Address - Phone:214-750-1962
Mailing Address - Fax:214-750-1611
Practice Address - Street 1:5315 N CENTRAL EXPY
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75205-3319
Practice Address - Country:US
Practice Address - Phone:214-750-1962
Practice Address - Fax:214-750-1611
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2008-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS726152W00000X
TX7202T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS02336052Medicaid
MS424298830AOtherBCBS
MS410000322Medicare ID - Type Unspecified
V02027Medicare UPIN