=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568411981
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CLIFFORD MARK BRITTAIN OD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/10/2006
-----------------------------------------------------
Last Update Date | 11/05/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 644 STATESVILLE BLVD STE 3
-----------------------------------------------------
City | SALISBURY
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28144-2280
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-633-8975
-----------------------------------------------------
Fax | 704-633-9160
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 644 STATESVILLE BL STE 3
-----------------------------------------------------
City | SALISBURY
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28144-2281
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-633-8975
-----------------------------------------------------
Fax | 704-633-9160
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 1178
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------