Provider Demographics
NPI:1790813699
Name:DR. VERNE E CLAUSSEN JR PA
Entity Type:Organization
Organization Name:DR. VERNE E CLAUSSEN JR PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VERNE
Authorized Official - Middle Name:E
Authorized Official - Last Name:CLAUSSEN
Authorized Official - Suffix:JR
Authorized Official - Credentials:OD
Authorized Official - Phone:785-437-2978
Mailing Address - Street 1:525 W BERTRAND AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT MARYS
Mailing Address - State:KS
Mailing Address - Zip Code:66536-1618
Mailing Address - Country:US
Mailing Address - Phone:785-437-2978
Mailing Address - Fax:785-437-6527
Practice Address - Street 1:525 W BERTRAND AVE
Practice Address - Street 2:
Practice Address - City:SAINT MARYS
Practice Address - State:KS
Practice Address - Zip Code:66536-1618
Practice Address - Country:US
Practice Address - Phone:785-437-2978
Practice Address - Fax:785-437-6527
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2012-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS994-3152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100089650AMedicaid
KS100089650AMedicaid
KS017106Medicare PIN
KST43619Medicare UPIN
KS017108Medicare PIN