Provider Demographics
NPI:1225003387
Name:MCCLAIN, LINDA M (OD)
Entity Type:Individual
Prefix:DR
First Name:LINDA
Middle Name:M
Last Name:MCCLAIN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:614 7TH ST
Mailing Address - Street 2:
Mailing Address - City:MARBLE FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:78654-5819
Mailing Address - Country:US
Mailing Address - Phone:830-693-3292
Mailing Address - Fax:830-693-8365
Practice Address - Street 1:614 7TH ST
Practice Address - Street 2:
Practice Address - City:MARBLE FALLS
Practice Address - State:TX
Practice Address - Zip Code:78654-5819
Practice Address - Country:US
Practice Address - Phone:830-693-3292
Practice Address - Fax:830-693-8365
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-22
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3071TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX019519001Medicaid
TXT92175Medicare UPIN
TX019519001Medicaid
TX00E81UMedicare PIN