Individual
CLIFTON G SITES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
ODT652
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
131605
BCBS
—
05
—
359237
—
TN
Enumeration date
08/10/2006
Last updated
05/05/2011
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