Provider Demographics
NPI:1477743953
Name:MCCLEARY, ERIN L (OD)
Entity Type:Individual
Prefix:DR
First Name:ERIN
Middle Name:L
Last Name:MCCLEARY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:MRS
Other - First Name:ERIN
Other - Middle Name:M
Other - Last Name:LINDQUIST
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:112 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PLAINVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06062-1944
Mailing Address - Country:US
Mailing Address - Phone:860-747-6443
Mailing Address - Fax:860-747-8019
Practice Address - Street 1:112 W MAIN ST
Practice Address - Street 2:
Practice Address - City:PLAINVILLE
Practice Address - State:CT
Practice Address - Zip Code:06062-1944
Practice Address - Country:US
Practice Address - Phone:860-747-6443
Practice Address - Fax:860-747-8019
Is Sole Proprietor?:No
Enumeration Date:2007-07-31
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002719152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT500000343Medicaid