Provider Demographics
NPI:1922015197
Name:CLIFT, CHRISTEN ROBERSON (OD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTEN
Middle Name:ROBERSON
Last Name:CLIFT
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:PO BOX 1599
Mailing Address - Street 2:
Mailing Address - City:CHICKASHA
Mailing Address - State:OK
Mailing Address - Zip Code:73023-1599
Mailing Address - Country:US
Mailing Address - Phone:405-224-5342
Mailing Address - Fax:405-222-2819
Practice Address - Street 1:619 W CHICKASHA AVE
Practice Address - Street 2:
Practice Address - City:CHICKASHA
Practice Address - State:OK
Practice Address - Zip Code:73018-2413
Practice Address - Country:US
Practice Address - Phone:405-224-5342
Practice Address - Fax:405-222-2819
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2012-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2155152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100732660AMedicaid
OK100766310DMedicaid
OK100766310DMedicaid
OK600522016Medicare ID - Type UnspecifiedGROUP #