Provider Demographics
NPI:1629119797
Name:MCDONEL, JAMES A (OD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:A
Last Name:MCDONEL
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 1:1176 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14209-2102
Mailing Address - Country:US
Mailing Address - Phone:716-881-7900
Mailing Address - Fax:716-887-2990
Practice Address - Street 1:1176 MAIN ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14209-2102
Practice Address - Country:US
Practice Address - Phone:716-881-7900
Practice Address - Fax:716-887-2990
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2012-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4214T78152W00000X
NYTUV007141-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
2220272OtherUNITED HEALTH CARE
OH0901224Medicaid
000000006965OtherANTHEM
NY02911700Medicaid
2220272OtherUNITED HEALTH CARE
000000006965OtherANTHEM
OH0901224Medicaid