Provider Demographics
NPI:1710089651
Name:CALLANAN, JAMES PATRICK (OD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:PATRICK
Last Name:CALLANAN
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 1:721 COMMONWEALTH AVE
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:VA
Mailing Address - Zip Code:24201-3321
Mailing Address - Country:US
Mailing Address - Phone:276-466-3420
Mailing Address - Fax:276-466-3387
Practice Address - Street 1:721 COMMONWEALTH AVE
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:VA
Practice Address - Zip Code:24201-3321
Practice Address - Country:US
Practice Address - Phone:276-466-3420
Practice Address - Fax:276-466-3387
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000021152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA92-0503-9Medicaid
VA580000050Medicare ID - Type Unspecified
VA92-0503-9Medicaid