Provider Demographics
NPI:1407977408
Name:CLARDY CONTACT LENS CENTER, INC.
Entity Type:Organization
Organization Name:CLARDY CONTACT LENS CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:WENDELL
Authorized Official - Last Name:CLARDY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:251-476-0100
Mailing Address - Street 1:3167 DAUPHIN ST
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36606-4061
Mailing Address - Country:US
Mailing Address - Phone:251-476-0100
Mailing Address - Fax:
Practice Address - Street 1:3167 DAUPHIN ST
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36606-4061
Practice Address - Country:US
Practice Address - Phone:251-476-0100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2012-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty