Provider Demographics
NPI:1326062449
Name:MCCLINTOCK, TOM RAY (OD)
Entity Type:Individual
Prefix:
First Name:TOM
Middle Name:RAY
Last Name:MCCLINTOCK
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 1:7638 STONEBROOK PKWY
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-1003
Mailing Address - Country:US
Mailing Address - Phone:972-712-1010
Mailing Address - Fax:972-712-1011
Practice Address - Street 1:7638 STONEBROOK PKWY
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-1003
Practice Address - Country:US
Practice Address - Phone:972-712-1010
Practice Address - Fax:972-712-1011
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4516TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1902852346OtherGROUP NPI
TXL0118195OtherDPS
TX00E41YOtherMEDICARE GROUP PIN
TX1326062449OtherNPI
TX1234530001OtherDMERC
TX752711435OtherGROUP TAX ID
TX752711435OtherGROUP TAX ID
TXL0118195OtherDPS
TXMM2262044OtherDEA
TX334458YSFPMedicare PIN