Provider Demographics
NPI:1851570881
Name:MADILL, JAMES BRENT (OD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:BRENT
Last Name:MADILL
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 1:665 N DOUTY ST
Mailing Address - Street 2:
Mailing Address - City:HANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:93230
Mailing Address - Country:US
Mailing Address - Phone:559-582-4316
Mailing Address - Fax:559-582-0519
Practice Address - Street 1:665 N DOUTY ST
Practice Address - Street 2:
Practice Address - City:HANFORD
Practice Address - State:CA
Practice Address - Zip Code:93230
Practice Address - Country:US
Practice Address - Phone:559-582-4316
Practice Address - Fax:559-582-0519
Is Sole Proprietor?:No
Enumeration Date:2007-10-26
Last Update Date:2009-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4519152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAI76536Medicare UPIN
CAAW129ZMedicare PIN
CA5428780001Medicare NSC