Provider Demographics
NPI:1033649231
Name:CONNOLLY, CLAY JAMES (OD)
Entity Type:Individual
Prefix:DR
First Name:CLAY
Middle Name:JAMES
Last Name:CONNOLLY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5959 LAWNDALE ST
Mailing Address - Street 2:
Mailing Address - City:LUDINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:49431-2921
Mailing Address - Country:US
Mailing Address - Phone:231-845-6261
Mailing Address - Fax:231-843-9171
Practice Address - Street 1:1775 S MITCHELL ST
Practice Address - Street 2:
Practice Address - City:CADILLAC
Practice Address - State:MI
Practice Address - Zip Code:49601-8533
Practice Address - Country:US
Practice Address - Phone:800-974-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901005063152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist