Provider Demographics
NPI:1922011410
Name:CLICK, CLED T (OD)
Entity Type:Individual
Prefix:DR
First Name:CLED
Middle Name:T
Last Name:CLICK
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 1:315 N 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:NM
Mailing Address - Zip Code:88415-3300
Mailing Address - Country:US
Mailing Address - Phone:575-374-2533
Mailing Address - Fax:575-374-2533
Practice Address - Street 1:315 N 3RD AVE
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:NM
Practice Address - Zip Code:88415-3300
Practice Address - Country:US
Practice Address - Phone:575-374-2533
Practice Address - Fax:575-374-2533
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM198152W00000X
TX1942152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMP00336378OtherRAILROAD MEDICARE
TX0196032-02Medicaid
NM94851069Medicaid
NM4659950001Medicare NSC
TXT12694Medicare UPIN
NMP00336378OtherRAILROAD MEDICARE
TX0196032-02Medicaid
TX00E65KMedicare Oscar/Certification