Individual
DR. CLINTON RUNNELLS MCLEAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
880 BRIDGEPORT AVE, SHELTON, CT 06484-4625
(203) 929-4030
(203) 929-9662
Mailing address
880 BRIDGEPORT AVE, SHELTON, CT 06484-4625
(203) 929-4030
(203) 929-9662
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
904
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0248660001
MEDICARE DMERC SUPPLIER
CT
01
—
090000904CT01
ANTHEM BCBS
CT
01
—
4271642
AETNA
CT
01
—
904000-4749
CONNECTICARE
CT
01
—
P606621
OXFORD HEALTH PLAN
CT
Enumeration date
09/21/2006
Last updated
07/08/2007
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