Provider Demographics
NPI:1487783007
Name:MCCLENAGHAN, NEIL SCOTT (OD)
Entity type:Individual
Prefix:DR
First Name:NEIL
Middle Name:SCOTT
Last Name:MCCLENAGHAN
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 1:10001 VENICE BLVD # 206
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90034-5806
Mailing Address - Country:US
Mailing Address - Phone:310-903-0691
Mailing Address - Fax:
Practice Address - Street 1:27011 MCBEAN PKWY STE 107
Practice Address - Street 2:
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-5148
Practice Address - Country:US
Practice Address - Phone:661-253-3888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13094152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist