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General NPI Number Information
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NPI Number | 1053650473
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Entity Type | Organization
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Legal Business Name | CLINTON OPHTHALMOLOGY, PC
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Dates
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Enumeration Date | 02/05/2013
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Last Update Date | 01/25/2017
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Provider Practice Location Address
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Address Line | 1000 E STURGIS ST SUITE 3
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City | SAINT JOHNS
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State | MI
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Zip | 48879-2068
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Country | US
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Telephone | 989-224-1452
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Fax | 989-224-1453
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Provider Business Mailing Address
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Address Line | 1000 E STURGIS ST SUITE 3
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City | SAINT JOHNS
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State | MI
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Zip | 48879-2068
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Country | US
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Telephone | 989-224-1452
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Fax | 989-224-1453
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Authorized Official
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Title or Position | PRESIDENT/PHYSICIAN
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Name | BRANDY ELIZABETH COOK
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Credential | DO
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Telephone | 989-224-1452
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 5101016172
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License Number State | MI
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