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Individual

DR. CARL BYRON MCINNISH

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
O.D,P.A.

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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