Provider Demographics
NPI:1336281120
Name:MCCLOUD, ROBERT DAVIS (OD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:DAVIS
Last Name:MCCLOUD
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 1:1800 SKIBO ROAD
Mailing Address - Street 2:SUITE 148B
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28303
Mailing Address - Country:US
Mailing Address - Phone:910-868-8599
Mailing Address - Fax:910-487-4070
Practice Address - Street 1:1800 SKIBO RD
Practice Address - Street 2:SUITE 148B
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28303
Practice Address - Country:US
Practice Address - Phone:910-868-8599
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC879152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8909563Medicaid