Provider Demographics
NPI:1912092727
Name:CLIFTON, BRUCE ALAN (OD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:ALAN
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 1:421 N LYNN RIGGS BLVD
Mailing Address - Street 2:
Mailing Address - City:CLAREMORE
Mailing Address - State:OK
Mailing Address - Zip Code:74017-5617
Mailing Address - Country:US
Mailing Address - Phone:918-343-7300
Mailing Address - Fax:918-343-7337
Practice Address - Street 1:421 N LYNN RIGGS BLVD
Practice Address - Street 2:
Practice Address - City:CLAREMORE
Practice Address - State:OK
Practice Address - Zip Code:74017-5617
Practice Address - Country:US
Practice Address - Phone:918-343-7300
Practice Address - Fax:918-343-7337
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2013-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2009152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100765080AMedicaid
OKDT1744Medicare PIN
OK100765080AMedicaid
OKU78383Medicare UPIN