Provider Demographics
NPI:1871599704
Name:MCLAIN, GREGORY DONALD (OD)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:DONALD
Last Name:MCLAIN
Suffix:
Gender:M
Credentials:OD
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Mailing Address - Street 1:17909 GADDY RD
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:OK
Mailing Address - Zip Code:74801-8717
Mailing Address - Country:US
Mailing Address - Phone:405-273-5153
Mailing Address - Fax:
Practice Address - Street 1:WEWOKA IHS HEALTH CENTER
Practice Address - Street 2:JUNCTION HWY 56&270
Practice Address - City:WEWOKA
Practice Address - State:OK
Practice Address - Zip Code:74884-1475
Practice Address - Country:US
Practice Address - Phone:800-390-5181
Practice Address - Fax:405-257-3344
Is Sole Proprietor?:No
Enumeration Date:2005-06-24
Last Update Date:2011-10-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WY114152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKU85222Medicare UPIN