Provider Demographics
NPI:1285640714
Name:CLOUSE, STEVEN J (OD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:J
Last Name:CLOUSE
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 1:2104 NE 59TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97213-4122
Mailing Address - Country:US
Mailing Address - Phone:503-238-1139
Mailing Address - Fax:503-235-6574
Practice Address - Street 1:2609 SE CLINTON ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-1240
Practice Address - Country:US
Practice Address - Phone:503-238-1139
Practice Address - Fax:503-235-6574
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR23408T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORU53604Medicare UPIN