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General NPI Number Information
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NPI Number | 1841273075
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Entity Type | Individual
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Provider Name | MICHAEL SHAWN MCCOY OD
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Gender | Male
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Dates
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Enumeration Date | 11/22/2005
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Last Update Date | 11/04/2024
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Provider Practice Location Address
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Address Line | 3013 S US HIGHWAY 41
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City | TERRE HAUTE
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State | IN
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Zip | 47802-3791
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Country | US
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Telephone | 812-234-4434
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Fax |
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Provider Business Mailing Address
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Address Line | 96 SOUTH ST
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City | GREENCASTLE
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State | IN
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Zip | 46135-2260
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Country | US
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Telephone | 765-653-9629
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 18003154
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License Number State | IN
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