Provider Demographics
NPI:1841470341
Name:J R MCCAUSLAND PC
Entity type:Organization
Organization Name:J R MCCAUSLAND PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:R
Authorized Official - Last Name:MCCAUSLAND
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:575-461-2431
Mailing Address - Street 1:415 S 2ND ST
Mailing Address - Street 2:
Mailing Address - City:TUCUMCARI
Mailing Address - State:NM
Mailing Address - Zip Code:88401-2859
Mailing Address - Country:US
Mailing Address - Phone:575-461-2431
Mailing Address - Fax:575-461-1246
Practice Address - Street 1:415 S 2ND ST
Practice Address - Street 2:
Practice Address - City:TUCUMCARI
Practice Address - State:NM
Practice Address - Zip Code:88401-2859
Practice Address - Country:US
Practice Address - Phone:575-461-2431
Practice Address - Fax:575-461-1246
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-13
Last Update Date:2009-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM128152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMP3957Medicaid
NMP3957Medicaid
NM0749360001Medicare NSC
NMT74913Medicare UPIN