Provider Demographics
NPI:1972688190
Name:MCCLURG, RICHARD C (OD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:C
Last Name:MCCLURG
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 1:20 S HIGH ST
Mailing Address - Street 2:
Mailing Address - City:CANAL WINCHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:43110-1251
Mailing Address - Country:US
Mailing Address - Phone:614-837-7725
Mailing Address - Fax:614-837-7301
Practice Address - Street 1:20 S HIGH ST
Practice Address - Street 2:
Practice Address - City:CANAL WINCHESTER
Practice Address - State:OH
Practice Address - Zip Code:43110-1251
Practice Address - Country:US
Practice Address - Phone:614-837-7725
Practice Address - Fax:614-837-7301
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2014-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2710-T-557152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0030933Medicaid
OH4701760001Medicare NSC
OHT-46094Medicare UPIN
OHP00387782Medicare PIN
OHMC-0157594Medicare ID - Type Unspecified