Provider Demographics
NPI:1851401061
Name:CLYDE, RITA JOY (OD)
Entity Type:Individual
Prefix:DR
First Name:RITA
Middle Name:JOY
Last Name:CLYDE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2118 VERNON AVE
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:NE
Mailing Address - Zip Code:68701-2371
Mailing Address - Country:US
Mailing Address - Phone:402-379-1865
Mailing Address - Fax:
Practice Address - Street 1:2400 W PASEWALK AVE
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68701-4608
Practice Address - Country:US
Practice Address - Phone:402-371-5715
Practice Address - Fax:402-371-6152
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NENE 1060152W00000X
SD510152W00000X
MN2437152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE170020OtherDYNTEK
NE550645OtherNVA
NE34993OtherAVESIS
NECL1415522OtherCLARITY VISION
NE10025049900Medicaid
NE47933OtherDAVIS VISION
NE04186OtherSPECTERA
NE36704OtherBCBS
NE920880OtherBLOCK VISION
NEU43421Medicare UPIN
NE265581Medicare ID - Type Unspecified