Provider Demographics
NPI:1093335440
Name:CARMEL CLEETUS, OD PLLC
Entity Type:Organization
Organization Name:CARMEL CLEETUS, OD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CARMEL
Authorized Official - Middle Name:M
Authorized Official - Last Name:CLEETUS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:915-588-1537
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:214-579-9920
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-24
Last Update Date:2020-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty