Provider Demographics
NPI:1477804037
Name:CLIFF, FREDRICK ARTHUR (OPTICIAN)
Entity Type:Individual
Prefix:
First Name:FREDRICK
Middle Name:ARTHUR
Last Name:CLIFF
Suffix:
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:POTSDAM
Mailing Address - State:NY
Mailing Address - Zip Code:13676-1854
Mailing Address - Country:US
Mailing Address - Phone:315-274-9181
Mailing Address - Fax:315-274-9180
Practice Address - Street 1:11 MAPLE ST
Practice Address - Street 2:
Practice Address - City:POTSDAM
Practice Address - State:NY
Practice Address - Zip Code:13676-1854
Practice Address - Country:US
Practice Address - Phone:315-274-9181
Practice Address - Fax:315-274-9180
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-24
Last Update Date:2012-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004739-1156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician