MEDICARE: PATRICK M. MCLAREN, O.D., P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	1896	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	093NN	OTHER	NC	BCBS

General Provider Information

NPI Number	:	1346329513
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PATRICK M. MCLAREN, O.D., P.A.

Provider Business Mailing Address
First Line	:	1122 N BREAZEALE AVE
Second Line	:
City	:	MOUNT OLIVE
State	:	NC
Zip	:	28365-1121
Country	:	US
Telephone Number	:	919-658-0474
Fax Number	:	919-658-0487

Provider Business Practice Location Address
First Line	:	1122 N BREAZEALE AVE
Second Line	:
City	:	MOUNT OLIVE
State	:	NC
Zip	:	28365-1121
Country	:	US
Telephone Number	:	919-658-0474
Fax Number	:	919-658-0487

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. PATRICK MICHAEL MCLAREN
Credential	:	O.D.
Telephone Number	:	919-658-0474

Provider Enumeration Date	:	11/06/2006
Last Update Date	:	03/28/2008

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