Provider Demographics
NPI:1164799706
Name:JEFFREY C. MCCLAIN, O.D., P.C.
Entity Type:Organization
Organization Name:JEFFREY C. MCCLAIN, O.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:CLAY
Authorized Official - Last Name:MCCLAIN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:615-893-0149
Mailing Address - Street 1:1132 W CLARK BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37129-2381
Mailing Address - Country:US
Mailing Address - Phone:615-893-0149
Mailing Address - Fax:615-849-9062
Practice Address - Street 1:1132 W CLARK BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129-2381
Practice Address - Country:US
Practice Address - Phone:615-893-0149
Practice Address - Fax:615-849-9062
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-28
Last Update Date:2013-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1024T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3585873Medicare UPIN