Provider Demographics
NPI:1912932666
Name:GLOVER-DANQUE, CLARISSA DAWN (OD)
Entity Type:Individual
Prefix:DR
First Name:CLARISSA
Middle Name:DAWN
Last Name:GLOVER-DANQUE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:CLARISSA
Other - Middle Name:DAWN
Other - Last Name:GLOVER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:275 W. 28TH STREET
Mailing Address - Street 2:SUITE 1
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-7304
Mailing Address - Country:US
Mailing Address - Phone:928-782-1980
Mailing Address - Fax:928-345-2950
Practice Address - Street 1:275 W. 28TH STREET
Practice Address - Street 2:SUITE 1
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-7304
Practice Address - Country:US
Practice Address - Phone:928-782-1980
Practice Address - Fax:928-345-2950
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2016-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1682152W00000X
ALS-A73-TA-641152W00000X
NC2535152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ136094Medicare PIN