Provider Demographics
NPI:1174699615
Name:MCCALL, JOHN ERIC (OD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ERIC
Last Name:MCCALL
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4504 TEXAS BLVD
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75503-3027
Mailing Address - Country:US
Mailing Address - Phone:903-792-3705
Mailing Address - Fax:
Practice Address - Street 1:4504 TEXAS BLVD
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-3027
Practice Address - Country:US
Practice Address - Phone:903-792-3705
Practice Address - Fax:903-794-5008
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-27
Last Update Date:2015-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6981T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR194776722Medicaid
TXTXB128437Medicare PIN
TX1304760001Medicare NSC