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General NPI Number Information
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NPI Number | 1871599704
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Entity Type | Individual
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Provider Name | GREGORY DONALD MCLAIN O.D.
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Gender | Male
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Dates
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Enumeration Date | 06/24/2005
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Last Update Date | 10/27/2011
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Provider Practice Location Address
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Address Line | WEWOKA IHS HEALTH CENTER JUNCTION HWY 56&270
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City | WEWOKA
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State | OK
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Zip | 74884-1475
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Country | US
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Telephone | 800-390-5181
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Fax | 405-257-3344
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Provider Business Mailing Address
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Address Line | 17909 GADDY RD
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City | SHAWNEE
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State | OK
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Zip | 74801-8717
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Country | US
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Telephone | 405-273-5153
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 114
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License Number State | WY
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