MEDICARE: DR. WILLIAM HALL MCCONNELL OD

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	TN-545	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073513636
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILLIAM HALL MCCONNELL OD

Provider Business Mailing Address
First Line	:	P.O. BOX 37
Second Line	:
City	:	CAMDEN
State	:	TN
Zip	:	38320
Country	:	US
Telephone Number	:	731-584-6161
Fax Number	:	731-584-6606

Provider Business Practice Location Address
First Line	:	194 W. MAIN ST.
Second Line	:
City	:	CAMDEN
State	:	TN
Zip	:	38320
Country	:	US
Telephone Number	:	731-584-6161
Fax Number	:	731-584-6606

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/26/2005
Last Update Date	:	07/08/2007

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