Provider Demographics
NPI:1669852356
Name:MCKISSICK, JAMES RANDALL II (OD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:RANDALL
Last Name:MCKISSICK
Suffix:II
Gender:M
Credentials:OD
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Mailing Address - Street 1:280 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CENTRE
Mailing Address - State:AL
Mailing Address - Zip Code:35960-1326
Mailing Address - Country:US
Mailing Address - Phone:256-927-4030
Mailing Address - Fax:256-927-2586
Practice Address - Street 1:280 W MAIN ST
Practice Address - Street 2:
Practice Address - City:CENTRE
Practice Address - State:AL
Practice Address - Zip Code:35960-1326
Practice Address - Country:US
Practice Address - Phone:256-927-4030
Practice Address - Fax:256-927-2586
Is Sole Proprietor?:No
Enumeration Date:2015-06-08
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ALS-D39152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist