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General NPI Number Information
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NPI Number | 1598919912
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Entity Type | Organization
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Legal Business Name | GARY T. CLOUD, OD PC
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Dates
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Enumeration Date | 11/12/2008
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Last Update Date | 12/17/2008
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Provider Practice Location Address
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Address Line | 559 HWY 281 N.
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City | ALICE
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State | TX
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Zip | 78332-0000
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Country | US
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Telephone | 361-664-2020
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Fax | 361-664-7852
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Provider Business Mailing Address
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Address Line | 559 HWY 281 N.
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City | ALICE
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State | TX
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Zip | 78332-0000
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Country | US
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Telephone | 361-664-2020
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Fax | 361-664-7852
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GARY T CLOUD
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Credential | D.O
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Telephone | 361-664-2020
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 2104T
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License Number State | TX
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