Provider Demographics
NPI:1932174406
Name:SINGLETON, CLYDE (OD)
Entity type:Individual
Prefix:DR
First Name:CLYDE
Middle Name:
Last Name:SINGLETON
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 1:7451 MCCART AVE
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76133-7296
Mailing Address - Country:US
Mailing Address - Phone:813-263-2020
Mailing Address - Fax:817-263-2021
Practice Address - Street 1:7451 MCCART AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76133-7296
Practice Address - Country:US
Practice Address - Phone:813-263-2020
Practice Address - Fax:817-263-2021
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-20
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6851-TG152W00000X
LA1293-440T152W00000X
TX6851TG152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1811560352Medicaid
TX1767246-02Medicaid
TX1767246-02Medicaid
TX612015Medicare ID - Type UnspecifiedMEDICARE PROVIDER ID