Provider Demographics
NPI:1568411981
Name:BRITTAIN, CLIFFORD MARK (OD)
Entity Type:Individual
Prefix:DR
First Name:CLIFFORD
Middle Name:MARK
Last Name:BRITTAIN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:644 STATESVILLE BL
Mailing Address - Street 2:STE 3
Mailing Address - City:SALISBURY
Mailing Address - State:NC
Mailing Address - Zip Code:28144-2281
Mailing Address - Country:US
Mailing Address - Phone:704-633-8975
Mailing Address - Fax:704-633-9160
Practice Address - Street 1:644 STATESVILLE BLVD
Practice Address - Street 2:STE 3
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28144-2280
Practice Address - Country:US
Practice Address - Phone:704-633-8975
Practice Address - Fax:704-633-9160
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2008-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1178152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89-09108Medicaid
NC2471077Medicare ID - Type Unspecified
NC89-09108Medicaid