Provider Demographics
NPI:1992960504
Name:SARAH E CLAY O D P C
Entity type:Organization
Organization Name:SARAH E CLAY O D P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:E
Authorized Official - Last Name:CLAY
Authorized Official - Suffix:
Authorized Official - Credentials:O D
Authorized Official - Phone:580-223-8676
Mailing Address - Street 1:226 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73401-6316
Mailing Address - Country:US
Mailing Address - Phone:580-223-8676
Mailing Address - Fax:580-223-8677
Practice Address - Street 1:226 W MAIN ST
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-6316
Practice Address - Country:US
Practice Address - Phone:580-223-8676
Practice Address - Fax:580-223-8677
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-23
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2517332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1720272164OtherNPI
OK1720272164OtherNPI