Organization
C B MCINNISH, OD PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CARL BYRON MCINNISH OD, PA (OWNER)
(251) 867-3635
Entity
Organization
Contact information
Practice address
106 W JACKSON ST, BREWTON, AL 36426-1516
(251) 867-3635
Mailing address
PO BOX 1268, BREWTON, AL 36427-1268
(251) 867-3635
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
S-312-TA-059
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
51092846
BLUE CROSS BLUE SHIELD
AL
Enumeration date
03/07/2007
Last updated
04/08/2008
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