Healthcare Provider Details

I. General information

NPI: 1326062449
Provider Name (Legal Business Name): TOM RAY MCCLINTOCK O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7638 STONEBROOK PKWY
FRISCO TX
75034-1003
US

IV. Provider business mailing address

7638 STONEBROOK PKWY
FRISCO TX
75034-1003
US

V. Phone/Fax

Practice location:
  • Phone: 972-712-1010
  • Fax: 972-712-1011
Mailing address:
  • Phone: 972-712-1010
  • Fax: 972-712-1011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4516TG
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: