Provider Demographics
NPI:1447403266
Name:CLOER, MARK FLYNT SR (ABOC, NCLE-AC)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:FLYNT
Last Name:CLOER
Suffix:SR
Gender:M
Credentials:ABOC, NCLE-AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:166 SUMAC DR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39110-9612
Mailing Address - Country:US
Mailing Address - Phone:601-856-4053
Mailing Address - Fax:
Practice Address - Street 1:166 SUMAC DR
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:MS
Practice Address - Zip Code:39110-9612
Practice Address - Country:US
Practice Address - Phone:601-856-4053
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-23
Last Update Date:2008-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FC0801XEye and Vision Services ProvidersTechnician/TechnologistContact Lens Fitter
No156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician