Provider Demographics
NPI:1407028103
Name:CLAREMORE VISION CENTER, INC
Entity Type:Organization
Organization Name:CLAREMORE VISION CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:CLIFTON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:918-343-7300
Mailing Address - Street 1:421 N LYNN RIGGS BLVD
Mailing Address - Street 2:
Mailing Address - City:CLAREMORE
Mailing Address - State:OK
Mailing Address - Zip Code:74017-5617
Mailing Address - Country:US
Mailing Address - Phone:918-343-7300
Mailing Address - Fax:918-343-7337
Practice Address - Street 1:421 N LYNN RIGGS BLVD
Practice Address - Street 2:
Practice Address - City:CLAREMORE
Practice Address - State:OK
Practice Address - Zip Code:74017-5617
Practice Address - Country:US
Practice Address - Phone:918-343-7300
Practice Address - Fax:918-343-7337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-02
Last Update Date:2013-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2009152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100765080AMedicaid
OK400522451Medicare PIN
OK100765080AMedicaid