Individual
JOHN W MCCLANE III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
6 SOUTH 14TH STREET, FERNANDINA BEACH, FL 32034
(904) 261-5741
(904) 261-7383
Mailing address
6 SOUTH 14TH STREET, FERNANDINA BEACH, FL 32034
(904) 261-5741
(904) 261-7383
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1488
FL
152W00000X
Optometrist
887
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00243911B
—
GA
05
—
00254141B
—
GA
05
—
00261797C
—
GA
05
—
959951220A
—
GA
Enumeration date
11/01/2006
Last updated
01/07/2019
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