Active NPI
Michael L McClintock I, M.D.
- Ophthalmology Physician
- Corbin, KY
National Provider Identifier
1790720506
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Ophthalmology Physician
- License
- 21428
- Practice address
- 205 S Kentucky Ave
Corbin, KY 40701-1533 - Phone
- (606) 528-0901
- Fax
- (606) 528-0903
- NPI assigned
- Jun 17, 2006
- 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 |
|---|---|---|---|---|
| Ophthalmology Physician | 207W00000X | 21428 | KY | Primary |
Addresses
Primary practice location
205 S Kentucky Ave
Corbin, KY 40701-1533
Mailing address
205 S Kentucky Ave
Corbin, KY 40701-1533
Phone (606) 528-0901
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 64-21428-1 | 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
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 21428 | KY | MD | Ophthalmology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1150502400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1790720506",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "205 S KENTUCKY AVE",
"city": "CORBIN",
"state": "KY",
"postal_code": "407011533",
"telephone_number": "606-528-0901",
"fax_number": "606-528-0903"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "205 S KENTUCKY AVE",
"city": "CORBIN",
"state": "KY",
"postal_code": "407011533",
"telephone_number": "606-528-0901",
"fax_number": "606-528-0903"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCCLINTOCK",
"first_name": "MICHAEL",
"middle_name": "L",
"name_prefix": "Dr.",
"name_suffix": "I",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-17",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "207W00000X",
"taxonomy_group": "",
"desc": "Ophthalmology",
"state": "KY",
"license": "21428",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "64-21428-1",
"state": "KY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Corbin, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.