MEDICARE: CRAIG ANTHONY MCCLUER 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	4953/T1823	OH
2	152W00000X	Optometrist	5694TG	TX

General Provider Information

NPI Number	:	1720070188
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRAIG ANTHONY MCCLUER O.D.

Provider Business Mailing Address
First Line	:	2131 PEPPERRELL ST STE 1
Second Line	:	BLDG 3350 / OPTOMETRY
City	:	LACKLAND AFB
State	:	TX
Zip	:	78236-5313
Country	:	US
Telephone Number	:	210-292-6582
Fax Number	:	210-292-7062

Provider Business Practice Location Address
First Line	:	2131 PEPPERRELL ST
Second Line	:	BLDG 3350 / OPTOMETRY
City	:	LACKLAND AFB
State	:	TX
Zip	:	78236-5313
Country	:	US
Telephone Number	:	210-292-6582
Fax Number	:	210-292-7062

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

Provider Enumeration Date	:	08/22/2005
Last Update Date	:	09/23/2008

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