Provider Demographics
NPI:1801809454
Name:CLIFTON, MONIE B (OD)
Entity type:Individual
Prefix:DR
First Name:MONIE
Middle Name:B
Last Name:CLIFTON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:439 CHANNEL ROAD
Mailing Address - Street 2:SUITE #103
Mailing Address - City:LAKE WYLIE
Mailing Address - State:SC
Mailing Address - Zip Code:29710
Mailing Address - Country:US
Mailing Address - Phone:803-746-7711
Mailing Address - Fax:803-746-7189
Practice Address - Street 1:439 CHANNEL ROAD
Practice Address - Street 2:SUITE #103
Practice Address - City:LAKE WYLIE
Practice Address - State:SC
Practice Address - Zip Code:29710
Practice Address - Country:US
Practice Address - Phone:803-746-7711
Practice Address - Fax:803-746-7189
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2005000535152W00000X
SC1447152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSC1447OtherEYEMED VISION
SCSC1447OtherEYEMED VISION