Provider Demographics
NPI:1033102249
Name:MCCLOUD, KAREN SANTOS (OD)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:SANTOS
Last Name:MCCLOUD
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:SANTOS
Other - Last Name:MCCLOUD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:110 CONN TER STE 550
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40508-3206
Mailing Address - Country:US
Mailing Address - Phone:859-323-5867
Mailing Address - Fax:859-323-8510
Practice Address - Street 1:110 CONN TER STE 550
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40508-3206
Practice Address - Country:US
Practice Address - Phone:859-323-5867
Practice Address - Fax:859-323-8510
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1628 DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000362108OtherANTHEM
KY77001303Medicaid
KY4589534OtherCIGNA
KY7643688OtherAETNA
KY77001303Medicaid
KY7643688OtherAETNA
KY4589534OtherCIGNA
KY0371707Medicare ID - Type UnspecifiedMCKEE
KY0371808Medicare ID - Type UnspecifiedRICHMOND
KY0572306Medicare ID - Type UnspecifiedIRVINE
KY0958006Medicare PIN