Provider Demographics
NPI:1780669994
Name:MCLAUGHLIN, JEFFREY L (OD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:L
Last Name:MCLAUGHLIN
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 1:1944 CHARLOTTE CT
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35630-6768
Mailing Address - Country:US
Mailing Address - Phone:256-394-1059
Mailing Address - Fax:
Practice Address - Street 1:2701 CLOVERDALE RD
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35633-1402
Practice Address - Country:US
Practice Address - Phone:256-712-6414
Practice Address - Fax:256-765-1563
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-09
Last Update Date:2014-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS-689-TA-255152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000058292OtherMEDICARE PTAN
AL000058292Medicare ID - Type Unspecified
ALU12421Medicare UPIN