Individual
FRED S CLONINGER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
406 S BROAD ST, SUITE A, GASTONIA, NC 28054-4304
(704) 865-3731
(704) 864-5736
Mailing address
406 S BROAD ST, SUITE A, GASTONIA, NC 28054-4304
(704) 865-3731
(704) 864-5736
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
804
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
410009765
RAILROAD MEDICARE
NC
05
—
8909163
—
NC
Enumeration date
09/21/2006
Last updated
10/02/2008
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