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General NPI Number Information
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NPI Number | 1497936256
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Entity Type | Organization
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Legal Business Name | MCCLOUD EYE CARE CENTER INC
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Dates
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Enumeration Date | 11/21/2007
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Last Update Date | 12/29/2011
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Provider Practice Location Address
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Address Line | 107 E MAIN ST
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City | GRAYSON
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State | KY
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Zip | 41143-1301
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Country | US
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Telephone | 606-474-5149
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Fax | 606-474-0648
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Provider Business Mailing Address
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Address Line | 107 E MAIN ST
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City | GRAYSON
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State | KY
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Zip | 41143-1301
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Country | US
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Telephone | 606-474-5149
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Fax | 606-474-0648
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. JASON H MCCLOUD
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Credential | OD
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Telephone | 606-474-5149
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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 | 1585DT
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License Number State | KY
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