Provider Demographics
NPI:1073558128
Name:CLAYTON EYE CLINIC OPTOMETRY PA
Entity Type:Organization
Organization Name:CLAYTON EYE CLINIC OPTOMETRY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:STRICKLAND
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:919-553-5600
Mailing Address - Street 1:11391 US HIGHWAY 70 W
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:NC
Mailing Address - Zip Code:27520-2205
Mailing Address - Country:US
Mailing Address - Phone:919-553-5600
Mailing Address - Fax:919-553-6707
Practice Address - Street 1:11391 US HIGHWAY 70 W
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:NC
Practice Address - Zip Code:27520-2205
Practice Address - Country:US
Practice Address - Phone:919-553-5600
Practice Address - Fax:919-553-6707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-20
Last Update Date:2011-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1092152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8909156Medicaid
NC8909156Medicaid
NC0145190001Medicare NSC
NCT65119Medicare UPIN