Individual
BARRY ANDREW CLEGG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
2352 POPLAR DR, MEDFORD, OR 97504-5297
(541) 772-2895
(541) 772-0531
Mailing address
PO BOX 1555, JACKSONVILLE, OR 97530-1555
(541) 772-2895
(541) 772-0531
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2531T
OR
152W00000X
Optometrist
620
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
075965
—
OR
Enumeration date
12/14/2006
Last updated
07/09/2007
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