Provider Demographics
NPI:1891755625
Name:MCLAREN, PATRICK MICHAEL (OD)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:MICHAEL
Last Name:MCLAREN
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 1:1122 N BREAZEALE AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT OLIVE
Mailing Address - State:NC
Mailing Address - Zip Code:28365-1121
Mailing Address - Country:US
Mailing Address - Phone:919-658-0474
Mailing Address - Fax:919-658-0487
Practice Address - Street 1:1122 N BREAZEALE AVE
Practice Address - Street 2:
Practice Address - City:MOUNT OLIVE
Practice Address - State:NC
Practice Address - Zip Code:28365-1121
Practice Address - Country:US
Practice Address - Phone:919-658-0474
Practice Address - Fax:919-658-0487
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-24
Last Update Date:2008-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1896152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0669420002OtherDMERC
NC093NNOtherBCBS
NC89093NNMedicaid
NC2472939CMedicare PIN
NC89093NNMedicaid