Provider Demographics
NPI:1063565299
Name:MCGINLEY, BRIAN B (OD)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:B
Last Name:MCGINLEY
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 1:2029 E. KENWOOD BL.
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53211-3310
Mailing Address - Country:US
Mailing Address - Phone:414-287-0070
Mailing Address - Fax:
Practice Address - Street 1:2634 N. DOWNER AVENUE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53211-4244
Practice Address - Country:US
Practice Address - Phone:414-964-3125
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2009-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2854152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
000147281Medicare PIN