Individual
DR. CARL BYRON MCINNISH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D,P.A.
Contact information
Practice address
106 W JACKSON ST, BREWTON, AL 36426-1516
(251) 867-3635
(251) 867-9523
Mailing address
PO BOX 1268, BREWTON, AL 36427-1268
(251) 867-3635
(251) 867-9523
Taxonomy
Speciality
Code
Description
License number
State
152WV0400X
Vision Therapy Optometrist
Primary
S-312-TA-059
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000059369
—
AL
01
—
000092846
BLUE CROSS BLUE SHIELD ID
AL
Enumeration date
05/10/2006
Last updated
10/12/2011
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