Provider Demographics
NPI:1134198328
Name:CLIFTON, DANNY R (OD)
Entity type:Individual
Prefix:DR
First Name:DANNY
Middle Name:R
Last Name:CLIFTON
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:PO BOX 737
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39339-0737
Mailing Address - Country:US
Mailing Address - Phone:662-773-5027
Mailing Address - Fax:662-773-2244
Practice Address - Street 1:200 W COLLEGE ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:MS
Practice Address - Zip Code:39339-2625
Practice Address - Country:US
Practice Address - Phone:662-773-5027
Practice Address - Fax:662-773-2244
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-17
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS445152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00087765Medicaid
MS00087765Medicaid
MST20891Medicare UPIN
MS560920628Medicare PIN