Healthcare Provider Details

I. General information

NPI: 1124336375
Provider Name (Legal Business Name): STEPHEN C MCCLINTIC, O.D. P.C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2010
Last Update Date: 09/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

444 S 1ST ST
HARRISON MI
48625-2500
US

IV. Provider business mailing address

444 S 1ST ST PO BOX 90
HARRISON MI
48625-2500
US

V. Phone/Fax

Practice location:
  • Phone: 989-539-2020
  • Fax: 989-539-2461
Mailing address:
  • Phone: 989-539-2020
  • Fax: 989-539-2461

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4901003123
License Number StateMI

VIII. Authorized Official

Name: MRS. ANGELA J LAPORTE
Title or Position: OFFICE MANAGER
Credential:
Phone: 989-539-2020