Active NPI
Robert Lee McClellan, OD
- Optometrist
- Bardstown, KY
National Provider Identifier
1265428940
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 704DT
- Practice address
- 115 S 5TH St
Bardstown, KY 40004-1108 - Phone
- (502) 348-5125
- Fax
- (502) 348-2485
- NPI assigned
- Sep 27, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 704DT | KY | Primary |
Addresses
Primary practice location
115 S 5TH St
Bardstown, KY 40004-1108
Mailing address
115 S 5TH St
Bardstown, KY 40004-1108
Phone (502) 348-5125
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 77007045 | Medicaid | KY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 704DT | KY | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1127779200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1363132800000",
"number": "1265428940",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "115 S 5TH ST",
"city": "BARDSTOWN",
"state": "KY",
"postal_code": "400041108",
"telephone_number": "502-348-5125",
"fax_number": "502-348-2485"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "115 S 5TH ST",
"city": "BARDSTOWN",
"state": "KY",
"postal_code": "400041108",
"telephone_number": "502-348-5125",
"fax_number": "502-348-2485"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCCLELLAN",
"first_name": "ROBERT",
"middle_name": "LEE",
"name_prefix": "Dr.",
"credential": "OD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-09-27",
"last_updated": "2013-03-13",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "KY",
"license": "704DT",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "77007045",
"state": "KY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Bardstown, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.