Provider Demographics
NPI:1497896591
Name:LE CLAIR, MICHAEL KARL (LDO)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:KARL
Last Name:LE CLAIR
Suffix:
Gender:M
Credentials:LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:171 E LINCOLN TRAIL BLVD
Mailing Address - Street 2:
Mailing Address - City:RADCLIFF
Mailing Address - State:KY
Mailing Address - Zip Code:40160-1253
Mailing Address - Country:US
Mailing Address - Phone:270-351-5367
Mailing Address - Fax:270-351-5367
Practice Address - Street 1:171 E LINCOLN TRAIL BLVD
Practice Address - Street 2:
Practice Address - City:RADCLIFF
Practice Address - State:KY
Practice Address - Zip Code:40160-1253
Practice Address - Country:US
Practice Address - Phone:270-351-5367
Practice Address - Fax:270-351-5367
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY0928156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician