Provider Demographics
NPI:1497853279
Name:CLANTON, KENNETH DOUGLAS (OD)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:DOUGLAS
Last Name:CLANTON
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 1:1312 MANATEE AVE E
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34208-1358
Mailing Address - Country:US
Mailing Address - Phone:941-750-8797
Mailing Address - Fax:941-750-8698
Practice Address - Street 1:1312 MANATEE AVE E
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34208-1358
Practice Address - Country:US
Practice Address - Phone:941-750-8797
Practice Address - Fax:941-750-8698
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2024-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOP881152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist