Provider Demographics
NPI:1316585102
Name:CLIETT, DEVRICK JAMAL SR (OPTICIAN OWNER)
Entity Type:Individual
Prefix:MR
First Name:DEVRICK
Middle Name:JAMAL
Last Name:CLIETT
Suffix:SR
Gender:M
Credentials:OPTICIAN OWNER
Other - Prefix:MR
Other - First Name:DEVRICK
Other - Middle Name:JAMAL
Other - Last Name:CLIETT
Other - Suffix:SR
Other - Last Name Type:Professional Name
Other - Credentials:DEVSOPTICS
Mailing Address - Street 1:207 E PARKWAY AVE
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19013-4610
Mailing Address - Country:US
Mailing Address - Phone:215-796-3434
Mailing Address - Fax:
Practice Address - Street 1:225 WILMINGTON PIKE
Practice Address - Street 2:SUITE 200
Practice Address - City:CHADDS FORD
Practice Address - State:PA
Practice Address - Zip Code:19317
Practice Address - Country:US
Practice Address - Phone:610-427-1144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-12
Last Update Date:2019-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician