1275367336 NPI number — CLOKEY FAMILY EYE CARE PLLC

Table of content: MONICA KRISTIN SAMELSON MD (NPI 1003279464)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275367336 NPI number — CLOKEY FAMILY EYE CARE PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CLOKEY FAMILY EYE CARE PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1275367336
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/29/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2360 LAKESHORE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GADSDEN
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35901-9202
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
256-393-1969
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
340 E MEIGHAN BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GADSDEN
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35903-1049
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-543-7762
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/29/2024

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
CLOKEY
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/OPTOMETRIST
Authorized Official Telephone Number:
256-393-1969

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)