=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992960504
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SARAH E CLAY O D P C
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/23/2008
-----------------------------------------------------
Last Update Date | 08/08/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 226 W MAIN ST
-----------------------------------------------------
City | ARDMORE
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73401-6316
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 580-223-8676
-----------------------------------------------------
Fax | 580-223-8677
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 226 W MAIN ST
-----------------------------------------------------
City | ARDMORE
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73401-6316
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 580-223-8676
-----------------------------------------------------
Fax | 580-223-8677
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PRESIDENT
-----------------------------------------------------
Name | DR. SARAH E CLAY
-----------------------------------------------------
Credential | O D
-----------------------------------------------------
Telephone | 580-223-8676
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332H00000X
-----------------------------------------------------
Taxonomy Name | Eyewear Supplier
-----------------------------------------------------
License Number | 2517
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------