Provider Demographics
NPI:1093827149
Name:ANDERSON, CLAYTON MANNING JR (OD)
Entity Type:Individual
Prefix:
First Name:CLAYTON
Middle Name:MANNING
Last Name:ANDERSON
Suffix:JR
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 1:2021 REVERE ROAD
Mailing Address - Street 2:
Mailing Address - City:CONNELLSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15425
Mailing Address - Country:US
Mailing Address - Phone:724-628-3960
Mailing Address - Fax:
Practice Address - Street 1:784 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:PA
Practice Address - Zip Code:15666
Practice Address - Country:US
Practice Address - Phone:724-547-6130
Practice Address - Fax:724-587-4750
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2013-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000579152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
410020130OtherPALMETTO GBA
0587150001OtherHEALTHNOW NY INC
77432OtherAETNA
PA0579OtherCOLE EYEMED
50552OtherDAVIS
0013245OtherDORAL
391976OtherNATIONAL VISION ADMINISTR
AN146070OtherPENNSYLVANIA BLUE SHIELD
0587150001OtherHEALTHNOW NY INC
AN146070OtherPENNSYLVANIA BLUE SHIELD