Provider Demographics
NPI:1831231505
Name:MCCAIN, KATHY YVONNE (OD)
Entity type:Individual
Prefix:DR
First Name:KATHY
Middle Name:YVONNE
Last Name:MCCAIN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6000 TOWN EAST MALL
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150-4132
Mailing Address - Country:US
Mailing Address - Phone:972-279-5411
Mailing Address - Fax:
Practice Address - Street 1:6000 TOWN EAST MALL
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-4132
Practice Address - Country:US
Practice Address - Phone:972-279-5411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4399152W00000X
FL1678152W00000X
GA955152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist