Provider Demographics
NPI:1215997549
Name:MCCLURE, ROBERT J (OD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:J
Last Name:MCCLURE
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 1:1426 ALTAMONT AVE
Mailing Address - Street 2:
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12303-2980
Mailing Address - Country:US
Mailing Address - Phone:518-355-0795
Mailing Address - Fax:518-355-1208
Practice Address - Street 1:1426 ALTAMONT AVE
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12303-2980
Practice Address - Country:US
Practice Address - Phone:518-550-7953
Practice Address - Fax:518-355-1208
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2018-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV0048671152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
T25899Medicare UPIN
NY53069KMedicare ID - Type Unspecified