Provider Demographics
NPI:1497769434
Name:CLAY, O. KEENE (OD)
Entity Type:Individual
Prefix:
First Name:O.
Middle Name:KEENE
Last Name:CLAY
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 1:22640 SE STARK ST
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030-2656
Mailing Address - Country:US
Mailing Address - Phone:503-667-0441
Mailing Address - Fax:503-666-6718
Practice Address - Street 1:22640 SE STARK ST
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-2656
Practice Address - Country:US
Practice Address - Phone:503-667-0441
Practice Address - Fax:503-666-6718
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1223T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR143685Medicaid
ORR137300Medicare PIN
ORT76649Medicare UPIN