Provider Demographics
NPI:1255362646
Name:CLIFT, GREGORY DALE (OD)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:DALE
Last Name:CLIFT
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:817 TOTTINGHAM RD
Mailing Address - Street 2:
Mailing Address - City:ANADARKO
Mailing Address - State:OK
Mailing Address - Zip Code:73005-5810
Mailing Address - Country:US
Mailing Address - Phone:405-247-2742
Mailing Address - Fax:
Practice Address - Street 1:115 N. E. OLDTOWN DR
Practice Address - Street 2:
Practice Address - City:ANADARKO
Practice Address - State:OK
Practice Address - Zip Code:73005
Practice Address - Country:US
Practice Address - Phone:405-247-2458
Practice Address - Fax:405-247-6653
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK974152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKT40397Medicare UPIN