Provider Demographics
NPI:1437303948
Name:GREG A MCCLURG
Entity Type:Organization
Organization Name:GREG A MCCLURG
Other - Org Name:MCCLURG VISION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GREG
Authorized Official - Middle Name:A
Authorized Official - Last Name:MCCLURG
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:865-577-6650
Mailing Address - Street 1:10721 CHAPMAN HWY
Mailing Address - Street 2:SUITE 5
Mailing Address - City:SEYMOUR
Mailing Address - State:TN
Mailing Address - Zip Code:37865-4765
Mailing Address - Country:US
Mailing Address - Phone:865-577-6650
Mailing Address - Fax:865-577-0452
Practice Address - Street 1:10721 CHAPMAN HWY
Practice Address - Street 2:SUITE 5
Practice Address - City:SEYMOUR
Practice Address - State:TN
Practice Address - Zip Code:37865-4765
Practice Address - Country:US
Practice Address - Phone:865-577-6650
Practice Address - Fax:865-577-0452
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-11
Last Update Date:2011-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNODT1631332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1213980001Medicare NSC