Provider Demographics
NPI:1356999130
Name:MCCASKILL, ANNA (LDO)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:MCCASKILL
Suffix:
Gender:F
Credentials:LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1890 BROWNING BEND CT
Mailing Address - Street 2:
Mailing Address - City:DACULA
Mailing Address - State:GA
Mailing Address - Zip Code:30019-7771
Mailing Address - Country:US
Mailing Address - Phone:678-663-3015
Mailing Address - Fax:
Practice Address - Street 1:1890 BROWNING BEND CT
Practice Address - Street 2:
Practice Address - City:DACULA
Practice Address - State:GA
Practice Address - Zip Code:30019-7771
Practice Address - Country:US
Practice Address - Phone:678-663-3015
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-26
Last Update Date:2022-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2607156FX1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1100XEye and Vision Services ProvidersTechnician/TechnologistOphthalmicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA842706523Medicaid