Provider Demographics
NPI:1306837885
Name:MCCLAIN, JEFFREY C (OD PC)
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:C
Last Name:MCCLAIN
Suffix:
Gender:M
Credentials:OD PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1132 W CLARK BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37129-2381
Mailing Address - Country:US
Mailing Address - Phone:615-893-0149
Mailing Address - Fax:615-849-9062
Practice Address - Street 1:1132 W CLARK BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129-2381
Practice Address - Country:US
Practice Address - Phone:615-893-0149
Practice Address - Fax:615-849-9062
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-02
Last Update Date:2011-11-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN1024T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3595873OtherMEDICARE TPAN
TN2003853OtherBCBS
TN3595873Medicaid
TN3595873OtherMEDICARE TPAN
TN2003853OtherBCBS