Provider Demographics
NPI:1184746570
Name:CHRISTINE T. CLANCEY, O.D., L.L.C
Entity type:Organization
Organization Name:CHRISTINE T. CLANCEY, O.D., L.L.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:T
Authorized Official - Last Name:CLANCEY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:856-429-4447
Mailing Address - Street 1:400 KINGS HWY E
Mailing Address - Street 2:
Mailing Address - City:HADDONFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:08033-1207
Mailing Address - Country:US
Mailing Address - Phone:856-429-4447
Mailing Address - Fax:
Practice Address - Street 1:421 S EGG HARBOR RD
Practice Address - Street 2:
Practice Address - City:HAMMONTON
Practice Address - State:NJ
Practice Address - Zip Code:08037-1417
Practice Address - Country:US
Practice Address - Phone:609-567-2586
Practice Address - Fax:609-567-7811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJOA005658152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJS84252Medicare UPIN
NJ042495Medicare ID - Type Unspecified