Provider Demographics
NPI:1790728350
Name:STOCK, CLIFFORD AARON (OD)
Entity Type:Individual
Prefix:DR
First Name:CLIFFORD
Middle Name:AARON
Last Name:STOCK
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 1:1020 SW SUNFLOWER DR
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64081-3756
Mailing Address - Country:US
Mailing Address - Phone:816-554-7223
Mailing Address - Fax:
Practice Address - Street 1:301 E COOPER ST
Practice Address - Street 2:
Practice Address - City:WARRENSBURG
Practice Address - State:MO
Practice Address - Zip Code:64093-1260
Practice Address - Country:US
Practice Address - Phone:660-747-7117
Practice Address - Fax:660-747-8020
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOT03038152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOU-80759Medicare UPIN
MO000A280Medicare ID - Type Unspecified