Provider Demographics
NPI:1194867317
Name:MCCLURG, GREG A (OD)
Entity Type:Individual
Prefix:DR
First Name:GREG
Middle Name:A
Last Name:MCCLURG
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10721 CHAPMAN HWY STE 5
Mailing Address - Street 2:
Mailing Address - City:SEYMOUR
Mailing Address - State:TN
Mailing Address - Zip Code:37865-4771
Mailing Address - Country:US
Mailing Address - Phone:865-577-6650
Mailing Address - Fax:865-577-0452
Practice Address - Street 1:10721 CHAPMAN HWY STE 5
Practice Address - Street 2:
Practice Address - City:SEYMOUR
Practice Address - State:TN
Practice Address - Zip Code:37865-4771
Practice Address - Country:US
Practice Address - Phone:865-577-6650
Practice Address - Fax:865-577-0452
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2011-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNODT1631152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN621714788OtherAETNA
TN621714788OtherCARITEN
TN621714788OtherCIGNA
TN3033647OtherBLUE CROSS BLUE SHIELD
TN3940328Medicaid
TN3033647OtherBLUE CROSS BLUE SHIELD
TNU44928Medicare UPIN