MEDICARE: DR. MEGAN MCCLURE O.D.

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	18003919A	IN

General Provider Information

NPI Number	:	1548639032
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MEGAN MCCLURE O.D.

Provider Business Mailing Address
First Line	:	12160 DRAGOON TRL
Second Line	:
City	:	MISHAWAKA
State	:	IN
Zip	:	46544-9716
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1212 N MAIN ST
Second Line	:
City	:	AUBURN
State	:	IN
Zip	:	46706-1200
Country	:	US
Telephone Number	:	260-925-1916
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/15/2015
Last Update Date	:	07/19/2016

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