Provider Demographics
NPI:1962505065
Name:CARTER, CLIFF J (OD)
Entity Type:Individual
Prefix:DR
First Name:CLIFF
Middle Name:J
Last Name:CARTER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:CLIFFORD
Other - Middle Name:J
Other - Last Name:CARTER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:289 HIGHLAND DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49201-9165
Mailing Address - Country:US
Mailing Address - Phone:517-522-6069
Mailing Address - Fax:517-817-2571
Practice Address - Street 1:1700 W MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49202-4005
Practice Address - Country:US
Practice Address - Phone:517-817-5261
Practice Address - Fax:517-817-5271
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901003986152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOPO2240Medicare ID - Type Unspecified