Individual
EDDIE DALE MCCLURE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OPTICIAN
Contact information
Practice address
5368 KENNESAW DR, BATON ROUGE, LA 70817-2555
(225) 753-0441
(225) 753-3320
Mailing address
3153 E TEXAS ST, BOSSIER CITY, LA 71111-3209
(225) 753-0441
(225) 753-3320
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
10-00013656
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1156612
—
LA
01
—
1508876095
MEDICAID NPI NUMBER
LA
Enumeration date
09/08/2011
Last updated
09/08/2011
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