Provider Demographics
NPI:1487816591
Name:MCLEOD EYE ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:MCLEOD EYE ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:MCLEOD
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:508-721-9701
Mailing Address - Street 1:385 SOUTHBRIDGE ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:AUBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01501-2498
Mailing Address - Country:US
Mailing Address - Phone:508-721-9701
Mailing Address - Fax:508-721-8951
Practice Address - Street 1:385 SOUTHBRIDGE ST
Practice Address - Street 2:SUITE 210
Practice Address - City:AUBURN
Practice Address - State:MA
Practice Address - Zip Code:01501-2498
Practice Address - Country:US
Practice Address - Phone:508-721-9701
Practice Address - Fax:508-721-8951
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-30
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3677152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW15845Medicare UPIN