Provider Demographics
NPI:1780649707
Name:CLASEN, JOHN R JR (OD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:R
Last Name:CLASEN
Suffix:JR
Gender:M
Credentials:OD
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Mailing Address - Street 1:230 E 10TH ST
Mailing Address - Street 2:SUITE 106
Mailing Address - City:ANNISTON
Mailing Address - State:AL
Mailing Address - Zip Code:36207-5784
Mailing Address - Country:US
Mailing Address - Phone:256-741-7340
Mailing Address - Fax:256-741-7373
Practice Address - Street 1:840 MONTCLAIR RD
Practice Address - Street 2:SUITE 722
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35213-1920
Practice Address - Country:US
Practice Address - Phone:205-591-2311
Practice Address - Fax:205-592-3531
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2017-02-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ALS-839-TA-366152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009911178Medicaid
ALU84531Medicare UPIN