Provider Demographics
NPI:1801844543
Name:MCCOY, WILLIAM EUGENE (OD)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:EUGENE
Last Name:MCCOY
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 1:405 W 4TH ST
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:MO
Mailing Address - Zip Code:65560-1212
Mailing Address - Country:US
Mailing Address - Phone:573-729-3937
Mailing Address - Fax:573-729-6298
Practice Address - Street 1:405 W 4TH ST
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:MO
Practice Address - Zip Code:65560-1212
Practice Address - Country:US
Practice Address - Phone:573-729-3937
Practice Address - Fax:573-729-6298
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2012-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOT02339152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO410011674OtherEDI
MO310570502Medicaid
MO410011674OtherEDI
MO310570502Medicaid