Provider Demographics
NPI:1245831783
Name:MCCONER, ANTHONY CURTIS SR (ABOC)
Entity type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:CURTIS
Last Name:MCCONER
Suffix:SR
Gender:M
Credentials:ABOC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:457 HIGHLAND ST SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49507-1204
Mailing Address - Country:US
Mailing Address - Phone:616-633-3752
Mailing Address - Fax:
Practice Address - Street 1:457 HIGHLAND ST SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49507-1204
Practice Address - Country:US
Practice Address - Phone:616-633-3752
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-02
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier