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General NPI Number Information
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NPI Number | 1164684833
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Entity Type | Organization
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Legal Business Name | DR G W CLAY P C
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Dates
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Enumeration Date | 06/25/2008
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Last Update Date | 08/26/2008
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Provider Practice Location Address
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Address Line | 226 W MAIN ST
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City | ARDMORE
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State | OK
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Zip | 73401-6316
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Country | US
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Telephone | 580-223-8676
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Fax | 580-223-8677
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Provider Business Mailing Address
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Address Line | 226 W MAIN ST
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City | ARDMORE
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State | OK
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Zip | 73401-6316
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Country | US
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Telephone | 580-223-8676
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Fax | 580-223-8677
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Authorized Official
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Title or Position | OPTOMETRIST/OWNER
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Name | DR. GARLAND W CLAY JR.
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Credential | O.D.
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Telephone | 580-223-8676
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | 891
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License Number State | OK
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