Provider Demographics
NPI:1306376561
Name:RADCLIFF, RHIANNON (DO)
Entity Type:Individual
Prefix:DR
First Name:RHIANNON
Middle Name:
Last Name:RADCLIFF
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2136 N KANSAS AVE
Mailing Address - Street 2:
Mailing Address - City:LIBERAL
Mailing Address - State:KS
Mailing Address - Zip Code:67901-2012
Mailing Address - Country:US
Mailing Address - Phone:620-624-3841
Mailing Address - Fax:620-624-0241
Practice Address - Street 1:2136 N KANSAS AVE
Practice Address - Street 2:
Practice Address - City:LIBERAL
Practice Address - State:KS
Practice Address - Zip Code:67901-2012
Practice Address - Country:US
Practice Address - Phone:620-624-3841
Practice Address - Fax:620-624-0241
Is Sole Proprietor?:No
Enumeration Date:2017-06-19
Last Update Date:2017-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2066152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist