Provider Demographics
NPI:1134551765
Name:JAMES L MCQUAIG JR OD & A BLAKE HUTTO OD
Entity type:Organization
Organization Name:JAMES L MCQUAIG JR OD & A BLAKE HUTTO OD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:BLAKE
Authorized Official - Last Name:HUTTO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:912-632-7623
Mailing Address - Street 1:410 E 16TH ST
Mailing Address - Street 2:
Mailing Address - City:ALMA
Mailing Address - State:GA
Mailing Address - Zip Code:31510-3008
Mailing Address - Country:US
Mailing Address - Phone:912-632-7623
Mailing Address - Fax:912-632-5816
Practice Address - Street 1:410 E 16TH ST
Practice Address - Street 2:
Practice Address - City:ALMA
Practice Address - State:GA
Practice Address - Zip Code:31510-3008
Practice Address - Country:US
Practice Address - Phone:912-632-7623
Practice Address - Fax:912-632-5816
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-06
Last Update Date:2014-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT 002764152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA202G706015Medicare PIN
GA41ZCBSLMedicare PIN
GA7087160001Medicare NSC
GADU2959Medicare PIN