Provider Demographics
NPI:1225091861
Name:MISHOCK-CLAPPER, SUSAN CHRISTINA (OD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:CHRISTINA
Last Name:MISHOCK-CLAPPER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:635 WALDO ST
Mailing Address - Street 2:
Mailing Address - City:GALLITZIN
Mailing Address - State:PA
Mailing Address - Zip Code:16641-2106
Mailing Address - Country:US
Mailing Address - Phone:814-884-2967
Mailing Address - Fax:
Practice Address - Street 1:926 LOGAN VALLEY MALL
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16602-2832
Practice Address - Country:US
Practice Address - Phone:814-942-3225
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001425152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA7386237Medicaid
PAMI964347OtherBLUE CROSS BLUE SHEILD
PAPA8077OtherEYEMED VISION CARE
PADA50984OtherDAVIS VISION
PAMI003253Medicare ID - Type Unspecified
PA7386237Medicaid