Provider Demographics
NPI:1619660834
Name:MCNEILL, SAMUEL JON (OD)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:JON
Last Name:MCNEILL
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 1:700 S CASS ST
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:MI
Mailing Address - Zip Code:49058-2039
Mailing Address - Country:US
Mailing Address - Phone:269-838-4427
Mailing Address - Fax:
Practice Address - Street 1:2001 E BLUEWATER HWY STE 100
Practice Address - Street 2:
Practice Address - City:IONIA
Practice Address - State:MI
Practice Address - Zip Code:48846-8725
Practice Address - Country:US
Practice Address - Phone:616-522-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-01
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901005698152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist