Provider Demographics
NPI:1306996632
Name:MCKINNEY, JOHN (OD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:MCKINNEY
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 1:27 BAKERTOWN RD
Mailing Address - Street 2:
Mailing Address - City:ACCORD
Mailing Address - State:NY
Mailing Address - Zip Code:12404-5901
Mailing Address - Country:US
Mailing Address - Phone:845-626-2379
Mailing Address - Fax:845-336-5890
Practice Address - Street 1:1300 ULSTER AVE
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-1501
Practice Address - Country:US
Practice Address - Phone:914-336-5878
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYT95381152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYT90578Medicare UPIN
NYC342B1Medicare ID - Type Unspecified