Provider Demographics
NPI:1366420127
Name:MCCLAIN, INGRID MARIE (OD)
Entity type:Individual
Prefix:DR
First Name:INGRID
Middle Name:MARIE
Last Name:MCCLAIN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:512 N LINE STREET
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA CITY
Mailing Address - State:IN
Mailing Address - Zip Code:46725-1330
Mailing Address - Country:US
Mailing Address - Phone:260-244-6474
Mailing Address - Fax:260-244-6815
Practice Address - Street 1:512 N LINE STREET
Practice Address - Street 2:
Practice Address - City:COLUMBIA CITY
Practice Address - State:IN
Practice Address - Zip Code:46725-1330
Practice Address - Country:US
Practice Address - Phone:260-244-6474
Practice Address - Fax:260-244-6815
Is Sole Proprietor?:No
Enumeration Date:2006-01-03
Last Update Date:2014-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18003167A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC478288Medicare ID - Type Unspecified