Provider Demographics
NPI:1518923341
Name:CLAUSEN, DAVID REID (OD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:REID
Last Name:CLAUSEN
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 1:620 E PHILLIPS DR S
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80122-2869
Mailing Address - Country:US
Mailing Address - Phone:303-730-9004
Mailing Address - Fax:
Practice Address - Street 1:7562 S UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80122-3159
Practice Address - Country:US
Practice Address - Phone:303-773-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO961152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO08961997Medicaid
COU38218Medicare UPIN
CO75113Medicare ID - Type Unspecified