Provider Demographics
NPI:1427227727
Name:CLAYTON M. ANDERSON, JR. O.D.
Entity Type:Organization
Organization Name:CLAYTON M. ANDERSON, JR. O.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CLAYTON
Authorized Official - Middle Name:M
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:OD
Authorized Official - Phone:724-547-6130
Mailing Address - Street 1:784 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:PA
Mailing Address - Zip Code:15666-1804
Mailing Address - Country:US
Mailing Address - Phone:724-547-6130
Mailing Address - Fax:724-547-4750
Practice Address - Street 1:784 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:PA
Practice Address - Zip Code:15666-1804
Practice Address - Country:US
Practice Address - Phone:724-547-6130
Practice Address - Fax:724-547-4750
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-21
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAPA0579OtherCOLE/EYEMED
PA50552OtherDAVIS
PAAN146070OtherBLUE CROSS BLUE SHIELD
PA77432OtherAETNA
PA410020130OtherPALMETTO GBA
PA0013245OtherDORAL
PA391976OtherNVA
PA50552OtherDAVIS
PA77432OtherAETNA