Provider Demographics
NPI:1598759250
Name:MCCLANAHAN, KARL (OD)
Entity Type:Individual
Prefix:DR
First Name:KARL
Middle Name:
Last Name:MCCLANAHAN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:KY
Mailing Address - Zip Code:40391-9591
Mailing Address - Country:US
Mailing Address - Phone:859-737-5599
Mailing Address - Fax:859-737-0650
Practice Address - Street 1:130 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:KY
Practice Address - Zip Code:40391-9591
Practice Address - Country:US
Practice Address - Phone:859-737-5599
Practice Address - Fax:859-737-0650
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-08
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1241-DT152W00000X
KY1241DT152WP0200X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY77903227Medicaid
KY1788201Medicare ID - Type Unspecified
KY77903227Medicaid
KYU32986Medicare UPIN