Healthcare Provider Details

I. General information

NPI: 1366429755
Provider Name (Legal Business Name): ROBERT N MCLEAR OD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/27/2005
Last Update Date: 02/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 W MAIN ST
GREENVILLE OH
45331-1401
US

IV. Provider business mailing address

133 W MAIN ST
GREENVILLE OH
45331-1401
US

V. Phone/Fax

Practice location:
  • Phone: 937-548-6111
  • Fax: 937-548-0893
Mailing address:
  • Phone: 937-548-6111
  • Fax: 937-548-0893

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3360/T148
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: