Provider Demographics
NPI:1699042077
Name:CLARDY, JOHN WENDELL (OD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:WENDELL
Last Name:CLARDY
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 1:3167 DAUPHIN ST
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36606-4061
Mailing Address - Country:US
Mailing Address - Phone:251-476-0100
Mailing Address - Fax:251-476-0152
Practice Address - Street 1:3167 DAUPHIN ST
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36606-4061
Practice Address - Country:US
Practice Address - Phone:251-476-0100
Practice Address - Fax:251-476-0152
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-29
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2012-008639152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist