Provider Demographics
NPI:1922886431
Name:HEAD, CLAIRE (OD)
Entity Type:Individual
Prefix:
First Name:CLAIRE
Middle Name:
Last Name:HEAD
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 1:5606 OAKCREST GREEN DR APT 202
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28217-0027
Mailing Address - Country:US
Mailing Address - Phone:859-230-7420
Mailing Address - Fax:
Practice Address - Street 1:2350 DAVE LYLE BLVD STE 101
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29730-9074
Practice Address - Country:US
Practice Address - Phone:803-399-0113
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-18
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2444152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist