Provider Demographics
NPI:1902930001
Name:MCPHERRAN, ANN K (OD)
Entity Type:Individual
Prefix:DR
First Name:ANN
Middle Name:K
Last Name:MCPHERRAN
Suffix:
Gender:F
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:PO BOX 886
Mailing Address - Street 2:
Mailing Address - City:PARADISE
Mailing Address - State:CA
Mailing Address - Zip Code:95967-0886
Mailing Address - Country:US
Mailing Address - Phone:530-872-1376
Mailing Address - Fax:530-872-3340
Practice Address - Street 1:5911 ALMOND ST
Practice Address - Street 2:
Practice Address - City:PARADISE
Practice Address - State:CA
Practice Address - Zip Code:95969-4508
Practice Address - Country:US
Practice Address - Phone:530-872-1376
Practice Address - Fax:530-872-3340
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT 9048 TPA152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0090480Medicaid
CA3401OtherMEDICAL EYE SERVICES #
CA410019521OtherRAILROAD MEDICARE #
FW633AMedicare PIN