MEDICARE: JA MCCALL CLINIC LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1629157177	OTHER	TX	NPI

General Provider Information

NPI Number	:	1063983039
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JA MCCALL CLINIC LLC

Provider Business Mailing Address
First Line	:	711 E GOLIAD AVE
Second Line	:
City	:	CROCKETT
State	:	TX
Zip	:	75835-2140
Country	:	US
Telephone Number	:	936-544-3763
Fax Number	:

Provider Business Practice Location Address
First Line	:	711 E GOLIAD AVE
Second Line	:
City	:	CROCKETT
State	:	TX
Zip	:	75835-2140
Country	:	US
Telephone Number	:	936-544-3763
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JOHN MCCALL JR.
Credential	:	OD
Telephone Number	:	936-544-3763

Provider Enumeration Date	:	12/17/2018
Last Update Date	:	06/11/2019

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Directions to “JA MCCALL CLINIC LLC ” Practice Location

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