Provider Demographics
NPI:1447215017
Name:MCCLUNE, ELIZABETH COLLIN (OD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:COLLIN
Last Name:MCCLUNE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:ELIZABETH
Other - Middle Name:R
Other - Last Name:COLLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:4301 WEST WILLIAM CANNON DRIVE
Mailing Address - Street 2:SUITE B210
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78749
Mailing Address - Country:US
Mailing Address - Phone:512-328-0015
Mailing Address - Fax:512-328-7638
Practice Address - Street 1:4301 W WILLIAM CANNON DR
Practice Address - Street 2:SUITE B210
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78749
Practice Address - Country:US
Practice Address - Phone:512-328-0015
Practice Address - Fax:512-328-7638
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2011-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA11809T152W00000X
TX7036TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU89924Medicare UPIN