MEDICARE: SAMUEL JON MCNEILL 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	4901005698	MI

General Provider Information

NPI Number	:	1619660834
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMUEL JON MCNEILL OD

Provider Business Mailing Address
First Line	:	700 S CASS ST
Second Line	:
City	:	HASTINGS
State	:	MI
Zip	:	49058-2039
Country	:	US
Telephone Number	:	269-838-4427
Fax Number	:

Provider Business Practice Location Address
First Line	:	2001 E BLUEWATER HWY STE 100
Second Line	:
City	:	IONIA
State	:	MI
Zip	:	48846-8725
Country	:	US
Telephone Number	:	616-522-1000
Fax Number	:

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

Provider Enumeration Date	:	06/01/2023
Last Update Date	:	06/01/2023

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