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General NPI Number Information
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NPI Number | 1922011410
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Entity Type | Individual
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Provider Name | CLED T CLICK O.D.
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Gender | Male
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Dates
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Enumeration Date | 08/14/2006
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Last Update Date | 01/18/2024
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Provider Practice Location Address
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Address Line | 315 N 3RD AVE
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City | CLAYTON
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State | NM
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Zip | 88415-3300
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Country | US
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Telephone | 575-374-2533
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Fax | 575-374-2533
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Provider Business Mailing Address
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Address Line | 315 N 3RD AVE
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City | CLAYTON
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State | NM
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Zip | 88415-3300
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Country | US
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Telephone | 575-374-2533
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Fax | 575-374-2533
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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 | 198
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License Number State | NM
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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 | 1942
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License Number State | TX
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