Provider Demographics
NPI:1003051194
Name:CLARKE, ALANE RENEE (LDO)
Entity type:Individual
Prefix:
First Name:ALANE
Middle Name:RENEE
Last Name:CLARKE
Suffix:
Gender:F
Credentials:LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8432 LOCKWOOD RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34243-2903
Mailing Address - Country:US
Mailing Address - Phone:941-359-1105
Mailing Address - Fax:941-359-1229
Practice Address - Street 1:8432 LOCKWOOD RIDGE RD
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34243-2903
Practice Address - Country:US
Practice Address - Phone:941-359-1105
Practice Address - Fax:941-359-1229
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-04
Last Update Date:2008-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDO3441156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL630372200Medicaid