Provider Demographics
NPI:1700376456
Name:MCNABB, CONNER JAY (OD)
Entity Type:Individual
Prefix:DR
First Name:CONNER
Middle Name:JAY
Last Name:MCNABB
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 1:810 KNIGHTS CROSS DR STE 101
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-2981
Mailing Address - Country:US
Mailing Address - Phone:210-495-9020
Mailing Address - Fax:210-495-9398
Practice Address - Street 1:810 KNIGHTS CROSS DR STE 101
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258
Practice Address - Country:US
Practice Address - Phone:210-831-0257
Practice Address - Fax:210-495-9398
Is Sole Proprietor?:No
Enumeration Date:2018-05-17
Last Update Date:2019-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9463T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist