Basic Information
| Provider Information | |||||||||
| NPI: | 1548265382 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MCCRARY | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | A. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | III, MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1315 ST JOSEPH PKWY | ||||||||
| Address2: | STE 1205 | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770028235 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7136593937 | ||||||||
| FaxNumber: | 7136592553 | ||||||||
| Practice Location | |||||||||
| Address1: | 1315 ST JOSEPH PKWY | ||||||||
| Address2: | STE 1205 | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770028235 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7136593937 | ||||||||
| FaxNumber: | 7136592553 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/17/2005 | ||||||||
| LastUpdateDate: | 07/08/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | D0226 | TX | N | Other Service Providers | Specialist | 207W00000X | D0226 | TX | Y | Allopathic & Osteopathic Physicians | Ophthalmology |
ID Information
| ID | Type | State | Issuer | Description | 1198533-03 | 05 | TX | MEDICAID |