Provider Demographics
NPI:1730207945
Name:MCLEAR, MELVILLE LEON (DISPENSER)
Entity type:Individual
Prefix:
First Name:MELVILLE
Middle Name:LEON
Last Name:MCLEAR
Suffix:
Gender:M
Credentials:DISPENSER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2477 COUNTY ROUTE 6
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:NY
Mailing Address - Zip Code:13646-4118
Mailing Address - Country:US
Mailing Address - Phone:315-375-6508
Mailing Address - Fax:315-375-4113
Practice Address - Street 1:3 LYON PL
Practice Address - Street 2:SUITE 304
Practice Address - City:OGDENSBURG
Practice Address - State:NY
Practice Address - Zip Code:13669-2590
Practice Address - Country:US
Practice Address - Phone:315-528-5474
Practice Address - Fax:315-375-4113
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY14000003334237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00468608Medicaid