Provider Demographics
NPI:1306042346
Name:CLARDY, GREGORY WALTER (OD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:WALTER
Last Name:CLARDY
Suffix:
Gender:M
Credentials:OD
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Mailing Address - Street 1:1408 BRAMBLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801
Mailing Address - Country:US
Mailing Address - Phone:256-658-7665
Mailing Address - Fax:256-922-1634
Practice Address - Street 1:6125 UNIVERSITY DRIVE
Practice Address - Street 2:SUITE D10
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35806
Practice Address - Country:US
Practice Address - Phone:256-922-1633
Practice Address - Fax:256-922-1634
Is Sole Proprietor?:No
Enumeration Date:2007-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5835TA385152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist