Provider Demographics
NPI:1407542053
Name:CLEAR SKY HOLDINGS, LLC
Entity Type:Organization
Organization Name:CLEAR SKY HOLDINGS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NIKITA
Authorized Official - Middle Name:
Authorized Official - Last Name:JABER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:616-465-5503
Mailing Address - Street 1:261 NETHERFIELD ST NW
Mailing Address - Street 2:
Mailing Address - City:COMSTOCK PARK
Mailing Address - State:MI
Mailing Address - Zip Code:49321-9343
Mailing Address - Country:US
Mailing Address - Phone:616-465-5503
Mailing Address - Fax:
Practice Address - Street 1:632 FULTON ST W STE 644
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49504-5313
Practice Address - Country:US
Practice Address - Phone:616-465-5503
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-17
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty