Provider Demographics
NPI:1831100460
Name:SITES, CLIFTON G (OD)
Entity Type:Individual
Prefix:
First Name:CLIFTON
Middle Name:G
Last Name:SITES
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 1:621 N RIVERSIDE DR
Mailing Address - Street 2:SITES VISION CLINIC
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37040
Mailing Address - Country:US
Mailing Address - Phone:931-647-5237
Mailing Address - Fax:931-647-5254
Practice Address - Street 1:621 N RIVERSIDE DR
Practice Address - Street 2:SITES VISION CLINIC
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37040
Practice Address - Country:US
Practice Address - Phone:931-647-5237
Practice Address - Fax:931-647-5254
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2011-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNODT652152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN359237Medicaid
131605OtherBCBS
T54653Medicare UPIN
131605OtherBCBS