Provider Demographics
NPI:1053339598
Name:MCCLINTIC, DAVID C (OD)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:C
Last Name:MCCLINTIC
Suffix:
Gender:M
Credentials:OD
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Mailing Address - Street 1:1700 S PARK
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49001
Mailing Address - Country:US
Mailing Address - Phone:269-342-0003
Mailing Address - Fax:269-342-4284
Practice Address - Street 1:6123 S WESTNEDGE AVE
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49002-2811
Practice Address - Country:US
Practice Address - Phone:269-327-7079
Practice Address - Fax:269-327-7165
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4901002757152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1053339598Medicaid
T91316Medicare UPIN
MI1053339598Medicaid
MI0733500000Medicare NSC