Clifford D Courtenay, O.D.
Individual provider Active NPI Optometrist · Valdosta, GA
NPI 1619982485 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1619982485
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- OPT00145 (GA)
- Practice address
- 3024 N Patterson St
Valdosta, GA 31602-1711 - Phone
- (229) 247-4114
- Fax
- (229) 245-9042
- NPI assigned
- Jul 30, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20081105000536 | GA | Practitioner - Optometry | 6709883192 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OPT00145 | GA | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Family Vision Care LLC | Optometrist | Current |
Accepting new patients |
Locations
131 Highway 32 Byp
Alma, GA 31510
Phone (912) 632-7623
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | OPT00145 | GA | Yes |
Addresses
Primary practice location
3024 N Patterson St
Valdosta, GA 31602-1711
Mailing address
3024 N Patterson St
Valdosta, GA 31602-1711
Phone (229) 247-4114
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000317138B | Medicaid | GA |
Other providers in Valdosta, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.