Provider Demographics
NPI:1205918539
Name:CLIFFORD, LORETTA A (OD)
Entity type:Individual
Prefix:DR
First Name:LORETTA
Middle Name:A
Last Name:CLIFFORD
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 1:125 US HIGHWAY 46
Mailing Address - Street 2:
Mailing Address - City:TOTOWA
Mailing Address - State:NJ
Mailing Address - Zip Code:07512-2338
Mailing Address - Country:US
Mailing Address - Phone:973-890-7070
Mailing Address - Fax:973-890-2787
Practice Address - Street 1:125 US HIGHWAY 46
Practice Address - Street 2:
Practice Address - City:TOTOWA
Practice Address - State:NJ
Practice Address - Zip Code:07512-2338
Practice Address - Country:US
Practice Address - Phone:973-890-7070
Practice Address - Fax:973-890-2787
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJOA04356152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJU17073Medicare UPIN
NJ647146DA1Medicare ID - Type Unspecified