Provider Demographics
NPI:1093157844
Name:CLEETUS, CARMEL MARY (OD)
Entity Type:Individual
Prefix:DR
First Name:CARMEL
Middle Name:MARY
Last Name:CLEETUS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11911 GREENVILLE AVE APT 4219
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-3686
Mailing Address - Country:US
Mailing Address - Phone:915-588-1537
Mailing Address - Fax:
Practice Address - Street 1:6464 E NORTHWEST HWY STE 212
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75214-7802
Practice Address - Country:US
Practice Address - Phone:214-579-9929
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-22
Last Update Date:2020-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8247T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist