Basic Information
| Provider Information | |||||||||
| NPI: | 1619993755 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MCCLATCHEY | ||||||||
| FirstName: | RONALD | ||||||||
| MiddleName: | T | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | OD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1700 SOUTH PARK | ||||||||
| Address2: | |||||||||
| City: | KALAMAZOO | ||||||||
| State: | MI | ||||||||
| PostalCode: | 49001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2693420003 | ||||||||
| FaxNumber: | 2693424284 | ||||||||
| Practice Location | |||||||||
| Address1: | 2350 44TH ST SE | ||||||||
| Address2: | |||||||||
| City: | KENTWOOD | ||||||||
| State: | MI | ||||||||
| PostalCode: | 495085016 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6162811011 | ||||||||
| FaxNumber: | 6162814941 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/14/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 4901002407 | MI | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.