Basic Information
| Provider Information | |||||||||
| NPI: | 1730148198 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STRATTON | ||||||||
| FirstName: | CLIFFORD | ||||||||
| MiddleName: | LEE | ||||||||
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| Credential: | OD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 167 MILL CREEK XING | ||||||||
| Address2: | |||||||||
| City: | MADISON | ||||||||
| State: | AL | ||||||||
| PostalCode: | 357587206 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2055670739 | ||||||||
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| Practice Location | |||||||||
| Address1: | 8089 HIGHWAY 72 W | ||||||||
| Address2: | SUITE A | ||||||||
| City: | MADISON | ||||||||
| State: | AL | ||||||||
| PostalCode: | 357589530 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2563259465 | ||||||||
| FaxNumber: | 2563259467 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/22/2006 | ||||||||
| LastUpdateDate: | 05/04/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152WC0802X | S939TA481 | AL | Y | Eye and Vision Services Providers | Optometrist | Corneal and Contact Management |
ID Information
| ID | Type | State | Issuer | Description | 1730148198 | 01 | AL | NPI | OTHER |