Healthcare Provider Details

I. General information

NPI: 1073513636
Provider Name (Legal Business Name): WILLIAM HALL MCCONNELL OD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/26/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

194 W. MAIN ST.
CAMDEN TN
38320
US

IV. Provider business mailing address

P.O. BOX 37
CAMDEN TN
38320
US

V. Phone/Fax

Practice location:
  • Phone: 731-584-6161
  • Fax: 731-584-6606
Mailing address:
  • Phone: 731-584-6161
  • Fax: 731-584-6606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberTN-545
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: