Provider Demographics
NPI:1053650473
Name:CLINTON OPHTHALMOLOGY, PC
Entity Type:Organization
Organization Name:CLINTON OPHTHALMOLOGY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:BRANDY
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:989-224-1452
Mailing Address - Street 1:1000 E STURGIS ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:SAINT JOHNS
Mailing Address - State:MI
Mailing Address - Zip Code:48879-2068
Mailing Address - Country:US
Mailing Address - Phone:989-224-1452
Mailing Address - Fax:989-224-1453
Practice Address - Street 1:1000 E STURGIS ST
Practice Address - Street 2:SUITE 3
Practice Address - City:SAINT JOHNS
Practice Address - State:MI
Practice Address - Zip Code:48879-2068
Practice Address - Country:US
Practice Address - Phone:989-224-1452
Practice Address - Fax:989-224-1453
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-05
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101016172207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty