Provider Demographics
NPI:1730339276
Name:MACDONALD, ANN MORGAN (OD)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:MORGAN
Last Name:MACDONALD
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:ANN
Other - Middle Name:MORGAN
Other - Last Name:TARTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:11520 BASE NAVAL CADIZ
Mailing Address - Street 2:
Mailing Address - City:FPO
Mailing Address - State:AE
Mailing Address - Zip Code:09645
Mailing Address - Country:US
Mailing Address - Phone:956-727-3495
Mailing Address - Fax:
Practice Address - Street 1:PSC 819 BOX 1
Practice Address - Street 2:
Practice Address - City:FPO
Practice Address - State:AE
Practice Address - Zip Code:09645-0001
Practice Address - Country:US
Practice Address - Phone:956-727-3495
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-21
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNTN2802152W00000X
OH5823152W00000X
KY1748DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist