Provider Demographics
NPI:1598919912
Name:GARY T. CLOUD, OD PC
Entity Type:Organization
Organization Name:GARY T. CLOUD, OD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:T
Authorized Official - Last Name:CLOUD
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:361-664-2020
Mailing Address - Street 1:559 HWY 281 N.
Mailing Address - Street 2:
Mailing Address - City:ALICE
Mailing Address - State:TX
Mailing Address - Zip Code:78332-0000
Mailing Address - Country:US
Mailing Address - Phone:361-664-2020
Mailing Address - Fax:361-664-7852
Practice Address - Street 1:559 HWY 281 N.
Practice Address - Street 2:
Practice Address - City:ALICE
Practice Address - State:TX
Practice Address - Zip Code:78332-0000
Practice Address - Country:US
Practice Address - Phone:361-664-2020
Practice Address - Fax:361-664-7852
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-12
Last Update Date:2008-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2104T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00Z945Medicare PIN