| Doctor Name: | MR. MICHAEL KARL LE CLAIR |
| NPI Number: | 1497896591 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LDO |
| License Number: | KY0928 |
| Business Practice Address: | 171 E Lincoln Trail Blvd Radcliff, KY - 401601253 |
| Business Phone Number: | 2703515367 |
| Business Fax Number: | 2703515367 |
| Mailing Address: | 171 E Lincoln Trail Blvd, RADCLIFF |
| State: | KY |
| Postal Code: | 401601253 |
| Phone Number: | 2703515367 |
| Fax Number: | 2703515367 |
| NPI Enumeration Date: | 02/09/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 156FX1800X |
| License Number: | KY0928 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | KY |
| Taxonomy Type: | Eye and Vision Services Providers |
| Taxonomy Classification: | Technician/Technologist |
| Taxonomy Specialization: | Optician |
| Taxonomy Definition: | |