Provider Demographics
NPI:1659443513
Name:CLAWSON, KEITH (OD)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:
Last Name:CLAWSON
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 1:3657 REGENCY LN
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-4245
Mailing Address - Country:US
Mailing Address - Phone:717-755-4126
Mailing Address - Fax:
Practice Address - Street 1:200 YORK GALLERIA
Practice Address - Street 2:WATERFORD RD RT 929
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17402-8979
Practice Address - Country:US
Practice Address - Phone:717-840-1919
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPAOEG762152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA511722Q1AMedicare ID - Type Unspecified
PAU01415Medicare UPIN