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General NPI Number Information
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NPI Number | 1124336375
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Entity Type | Organization
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Legal Business Name | STEPHEN C MCCLINTIC, O.D. P.C
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Dates
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Enumeration Date | 09/22/2010
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Last Update Date | 09/22/2010
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Provider Practice Location Address
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Address Line | 444 S 1ST ST
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City | HARRISON
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State | MI
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Zip | 48625-2500
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Country | US
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Telephone | 989-539-2020
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Fax | 989-539-2461
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Provider Business Mailing Address
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Address Line | 444 S 1ST ST PO BOX 90
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City | HARRISON
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State | MI
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Zip | 48625-2500
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Country | US
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Telephone | 989-539-2020
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Fax | 989-539-2461
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. ANGELA J LAPORTE
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Credential |
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Telephone | 989-539-2020
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 4901003123
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License Number State | MI
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