Provider Demographics
NPI:1881669802
Name:MCCLAY, MICHAEL C (OD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:C
Last Name:MCCLAY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:7499 PARKLANE RD
Mailing Address - Street 2:SUITE 160
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29223-7650
Mailing Address - Country:US
Mailing Address - Phone:803-741-7177
Mailing Address - Fax:803-741-7776
Practice Address - Street 1:7499 PARKLANE RD
Practice Address - Street 2:SUITE 160
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29223-7650
Practice Address - Country:US
Practice Address - Phone:803-741-7177
Practice Address - Fax:803-741-7776
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-22
Last Update Date:2016-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC579152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC393278Medicaid
SC393278Medicaid
SCT251861379Medicare PIN