Provider Demographics
NPI:1053518647
Name:MCCLAIN, NATHAN ALAN (OD)
Entity type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:ALAN
Last Name:MCCLAIN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3250 W. 16TH STREET
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:IN
Mailing Address - Zip Code:47421-3503
Mailing Address - Country:US
Mailing Address - Phone:812-279-3466
Mailing Address - Fax:812-279-3701
Practice Address - Street 1:3250 W. 16TH ST
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:IN
Practice Address - Zip Code:47421-3503
Practice Address - Country:US
Practice Address - Phone:812-279-3466
Practice Address - Fax:812-279-3701
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-28
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18003463A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200870690Medicaid
IN200870690Medicaid