Provider Demographics
NPI:1609989508
Name:MCDONALD, JOHN E (OD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:E
Last Name:MCDONALD
Suffix:
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 1:443 STILSON CANYON RD
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95928-9118
Mailing Address - Country:US
Mailing Address - Phone:530-894-0443
Mailing Address - Fax:
Practice Address - Street 1:245 N VILLA AVE
Practice Address - Street 2:
Practice Address - City:WILLOWS
Practice Address - State:CA
Practice Address - Zip Code:95988-2607
Practice Address - Country:US
Practice Address - Phone:530-934-3373
Practice Address - Fax:530-934-3522
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2010-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7006T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA3282OtherMESC
CASD0070060Medicaid
CA999995883OtherVSP
CA086526OtherHEALTHNET
CA953859174OtherPRINCIPAL
CASD0070060Medicare PIN
CA086526OtherHEALTHNET