Provider Demographics
NPI:1760434351
Name:WESTPHAL, CLAYTON CARL (OD)
Entity Type:Individual
Prefix:
First Name:CLAYTON
Middle Name:CARL
Last Name:WESTPHAL
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 1:16840 W SAGUARO LN
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85388-1309
Mailing Address - Country:US
Mailing Address - Phone:623-556-9141
Mailing Address - Fax:
Practice Address - Street 1:6525 W SACK DR
Practice Address - Street 2:#306
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-7104
Practice Address - Country:US
Practice Address - Phone:623-561-1995
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1505152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ116455Medicare PIN