Provider Demographics
NPI:1861470189
Name:CLOUSER, JOHN D (OD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:D
Last Name:CLOUSER
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 1:929 S HIGH ST
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19382-5466
Mailing Address - Country:US
Mailing Address - Phone:610-696-1415
Mailing Address - Fax:610-696-8308
Practice Address - Street 1:929 S HIGH ST
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19382-5466
Practice Address - Country:US
Practice Address - Phone:610-696-1415
Practice Address - Fax:610-696-8308
Is Sole Proprietor?:No
Enumeration Date:2006-01-06
Last Update Date:2016-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA0E5207P152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA580000571OtherRAILROAD MEDICARE
PA580000571OtherRAILROAD MEDICARE
T29966Medicare UPIN
PA0338090001Medicare NSC