MEDICARE: DR. DANNY R CLIFTON OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	445	MS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134198328
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DANNY R CLIFTON OD

Provider Business Mailing Address
First Line	:	PO BOX 737
Second Line	:
City	:	LOUISVILLE
State	:	MS
Zip	:	39339-0737
Country	:	US
Telephone Number	:	662-773-5027
Fax Number	:	662-773-2244

Provider Business Practice Location Address
First Line	:	200 W COLLEGE ST
Second Line	:
City	:	LOUISVILLE
State	:	MS
Zip	:	39339-2625
Country	:	US
Telephone Number	:	662-773-5027
Fax Number	:	662-773-2244

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/17/2006
Last Update Date	:	04/30/2008

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