Provider Demographics
NPI:1033294251
Name:ALUISE, CLINTON A (ABOC)
Entity Type:Individual
Prefix:MR
First Name:CLINTON
Middle Name:A
Last Name:ALUISE
Suffix:
Gender:M
Credentials:ABOC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2442 GUNNISON AVE
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81501-7948
Mailing Address - Country:US
Mailing Address - Phone:970-244-8480
Mailing Address - Fax:970-244-6995
Practice Address - Street 1:618 WALNUT AVE
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-7400
Practice Address - Country:US
Practice Address - Phone:970-244-8665
Practice Address - Fax:970-244-6995
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO05717156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1169130001Medicare ID - Type Unspecified