MEDICARE: WILLIAM G MCINNISH 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	S436TA060	AL

General Provider Information

NPI Number	:	1730151739
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM G MCINNISH OD

Provider Business Mailing Address
First Line	:	PO BOX 2010
Second Line	:
City	:	BAY MINETTE
State	:	AL
Zip	:	36507-2010
Country	:	US
Telephone Number	:	251-937-6582
Fax Number	:	251-937-6614

Provider Business Practice Location Address
First Line	:	2003 MEDICAL CENTER DR
Second Line	:
City	:	BAY MINETTE
State	:	AL
Zip	:	36507-4163
Country	:	US
Telephone Number	:	251-937-6582
Fax Number	:	251-937-6614

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

Provider Enumeration Date	:	02/03/2006
Last Update Date	:	03/12/2008

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