Provider Demographics
NPI:1225299407
Name:CLOUSING, DANIEL PAUL (OD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:PAUL
Last Name:CLOUSING
Suffix:
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 1:18488 KEYSER CREEK AVE
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80134-7670
Mailing Address - Country:US
Mailing Address - Phone:616-446-0041
Mailing Address - Fax:
Practice Address - Street 1:210 ELIZABETH ST
Practice Address - Street 2:SUITE 'B'
Practice Address - City:ELIZABETH
Practice Address - State:CO
Practice Address - Zip Code:80107-7538
Practice Address - Country:US
Practice Address - Phone:303-646-8888
Practice Address - Fax:303-646-8880
Is Sole Proprietor?:No
Enumeration Date:2008-06-20
Last Update Date:2009-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOPT-2654152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCO301439Medicare PIN