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General NPI Number Information
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NPI Number | 1851401061
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Entity Type | Individual
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Provider Name | RITA JOY CLYDE O.D.
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Gender | Female
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Dates
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Enumeration Date | 08/30/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2400 W PASEWALK AVE
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City | NORFOLK
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State | NE
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Zip | 68701-4608
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Country | US
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Telephone | 402-371-5715
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Fax | 402-371-6152
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Provider Business Mailing Address
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Address Line | 2118 VERNON AVE
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City | NORFOLK
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State | NE
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Zip | 68701-2371
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Country | US
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Telephone | 402-379-1865
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | NE 1060
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License Number State | NE
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 510
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License Number State | SD
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Taxonomy #3
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 2437
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License Number State | MN
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