Provider Demographics
NPI:1689840027
Name:BILL MCCOY, O.D., P.C.
Entity Type:Organization
Organization Name:BILL MCCOY, O.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BILL
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCOY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:573-729-3937
Mailing Address - Street 1:405 W 4TH ST
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:MO
Mailing Address - Zip Code:65560-1212
Mailing Address - Country:US
Mailing Address - Phone:573-729-3937
Mailing Address - Fax:573-729-6298
Practice Address - Street 1:405 W 4TH ST
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:MO
Practice Address - Zip Code:65560-1212
Practice Address - Country:US
Practice Address - Phone:573-729-3937
Practice Address - Fax:573-729-6298
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-06
Last Update Date:2011-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOT02239152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO108570OtherBLUE CROS BLUE SHIELD OF MISSOURI
MO310570502Medicaid
MO6480860001Medicare NSC
MO108570OtherBLUE CROS BLUE SHIELD OF MISSOURI