Provider Demographics
NPI:1962401059
Name:MCCLOY, DOUGLAS R II (OD)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:R
Last Name:MCCLOY
Suffix:II
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 1:254 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:OH
Mailing Address - Zip Code:43302
Mailing Address - Country:US
Mailing Address - Phone:740-387-6880
Mailing Address - Fax:740-387-7443
Practice Address - Street 1:254 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:OH
Practice Address - Zip Code:43302
Practice Address - Country:US
Practice Address - Phone:740-387-6880
Practice Address - Fax:740-387-7443
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4665 T1440152W00000X
OHOH4665152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1791851OtherUNITED HEALTHCARE
OH410048818OtherRAILROAD MEDICARE
OH2036764Medicaid
OH410048891OtherRAILROAD MEDICARE
OH5340225OtherAETNA
OH000000223971OtherANTHEM
OH2036764Medicaid
OHMC0802818Medicare PIN
OH410048891OtherRAILROAD MEDICARE
OH802817Medicare PIN
OH0802818Medicare PIN