Provider Demographics
NPI:1518925791
Name:LOFTIS, CLARENCE EARL JR (OD)
Entity Type:Individual
Prefix:DR
First Name:CLARENCE
Middle Name:EARL
Last Name:LOFTIS
Suffix:JR
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 1:1219 LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201-3135
Mailing Address - Country:US
Mailing Address - Phone:803-799-2020
Mailing Address - Fax:803-799-2035
Practice Address - Street 1:1219 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-3135
Practice Address - Country:US
Practice Address - Phone:803-799-2020
Practice Address - Fax:803-799-2035
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2008-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC636152W00000X
KY0916D152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCD06363Medicaid
SCD06363Medicaid
SCT24678Medicare UPIN