Healthcare Provider Details

I. General information

NPI: 1871737239
Provider Name (Legal Business Name): MICHAEL LEWIS MCCLINTOCK JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2009
Last Update Date: 03/27/2026
Certification Date: 03/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6125 AIRPORT RD
ROANOKE VA
24019-3813
US

IV. Provider business mailing address

1819 ELECTRIC RD STE 1B
ROANOKE VA
24018-1605
US

V. Phone/Fax

Practice location:
  • Phone: 540-344-4000
  • Fax: 540-682-1155
Mailing address:
  • Phone: 540-344-4000
  • Fax: 540-682-1155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number0101257712
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number0101257712
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: