Provider Demographics
NPI:1477783421
Name:CLYDE, ERIC MICHAEL (OD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:MICHAEL
Last Name:CLYDE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3050 N 44TH ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-7265
Mailing Address - Country:US
Mailing Address - Phone:480-215-9935
Mailing Address - Fax:602-955-3282
Practice Address - Street 1:3050 N 44TH ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-7265
Practice Address - Country:US
Practice Address - Phone:602-955-2700
Practice Address - Fax:602-955-3282
Is Sole Proprietor?:No
Enumeration Date:2009-07-23
Last Update Date:2015-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1703152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist