Provider Demographics
NPI:1295765493
Name:MCCAULEY, JAMES MICHAEL (OD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:MICHAEL
Last Name:MCCAULEY
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:PO BOX 38
Mailing Address - Street 2:
Mailing Address - City:PERRY
Mailing Address - State:IA
Mailing Address - Zip Code:50220-0038
Mailing Address - Country:US
Mailing Address - Phone:515-465-4203
Mailing Address - Fax:515-465-5373
Practice Address - Street 1:1313 2ND ST
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:IA
Practice Address - Zip Code:50220-1511
Practice Address - Country:US
Practice Address - Phone:515-465-4203
Practice Address - Fax:515-465-5373
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2008-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA152 01625152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0147579Medicaid
IADN4532OtherMEDICARE RAILROAD
IA3147579Medicaid
IA1147579Medicaid
IA2147579Medicaid
IAP00230147OtherRAILROAD MEDICARE
IAP00620439OtherMEDICARE RAILROAD
IA0547170002OtherDMERC
IA4147579Medicaid
IA2147579Medicaid
IA29249Medicare PIN
IA29245Medicare PIN
IA3147579Medicaid
IAP00230147OtherRAILROAD MEDICARE
IA0147579Medicaid