Provider Demographics
NPI:1912088592
Name:MCCALLEN, ERIN B (OD)
Entity Type:Individual
Prefix:MRS
First Name:ERIN
Middle Name:B
Last Name:MCCALLEN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:501 SIGNAL MOUNTAIN RD
Mailing Address - Street 2:C/O WAL-MART
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37405-1919
Mailing Address - Country:US
Mailing Address - Phone:423-309-8542
Mailing Address - Fax:423-756-6908
Practice Address - Street 1:501 SIGNAL MOUNTAIN RD
Practice Address - Street 2:C/O WAL-MART
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37405-1919
Practice Address - Country:US
Practice Address - Phone:423-309-8542
Practice Address - Fax:423-756-6908
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2012-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNTOD1499152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNTOD1499OtherOPTOMTRIST