Provider Demographics
NPI:1548546526
Name:DEANA M CLIFTON A PROFESSIONAL OPTOMETRY CORPORATION
Entity type:Organization
Organization Name:DEANA M CLIFTON A PROFESSIONAL OPTOMETRY CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/ OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DEANA
Authorized Official - Middle Name:M
Authorized Official - Last Name:CLIFTON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:318-550-5815
Mailing Address - Street 1:1000 CHINABERRY DR
Mailing Address - Street 2:SUITE 302
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71111-2438
Mailing Address - Country:US
Mailing Address - Phone:318-550-5815
Mailing Address - Fax:318-550-5686
Practice Address - Street 1:1000 CHINABERRY DR
Practice Address - Street 2:SUITE 302
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71111-2438
Practice Address - Country:US
Practice Address - Phone:318-550-5815
Practice Address - Fax:318-550-5686
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-23
Last Update Date:2012-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1426-561T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty