Provider Demographics
NPI:1609838044
Name:MCCLENATHAN, ROBERT A (OD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:A
Last Name:MCCLENATHAN
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 1:244 N QUEEN ST
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17603-3512
Mailing Address - Country:US
Mailing Address - Phone:717-735-0746
Mailing Address - Fax:717-291-9183
Practice Address - Street 1:244 N QUEEN ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17603-3512
Practice Address - Country:US
Practice Address - Phone:717-735-0746
Practice Address - Fax:717-291-9183
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-03
Last Update Date:2009-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000699152W00000X, 152WL0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAOEG000699OtherSTATE LICENSE
PAOEG000699OtherSTATE LICENSE
PAT29909Medicare UPIN
PA172416Medicare ID - Type Unspecified