Healthcare Provider Details

I. General information

NPI: 1174699615
Provider Name (Legal Business Name): JOHN ERIC MCCALL O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/27/2006
Last Update Date: 04/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4504 TEXAS BLVD
TEXARKANA TX
75503-3027
US

IV. Provider business mailing address

4504 TEXAS BLVD
TEXARKANA TX
75503-3027
US

V. Phone/Fax

Practice location:
  • Phone: 903-792-3705
  • Fax: 903-794-5008
Mailing address:
  • Phone: 903-792-3705
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number6981T
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: