Provider Demographics
NPI:1184600157
Name:MCEACHERN, DONALD ALVIN (MD)
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:ALVIN
Last Name:MCEACHERN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1511 TAMIAMI TRL S
Mailing Address - Street 2:SUITE 201
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34285-5546
Mailing Address - Country:US
Mailing Address - Phone:941-497-2138
Mailing Address - Fax:941-493-2598
Practice Address - Street 1:1511 TAMIAMI TRL S
Practice Address - Street 2:SUITE 201
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34285-5546
Practice Address - Country:US
Practice Address - Phone:941-497-2138
Practice Address - Fax:941-493-2598
Is Sole Proprietor?:No
Enumeration Date:2005-12-21
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME34419207W00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD53886Medicare UPIN
FL30192Medicare ID - Type Unspecified