Provider Demographics
NPI:1972507614
Name:CLOPTON, JASON C (OD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:C
Last Name:CLOPTON
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1080 NEAL ST
Mailing Address - Street 2:STE 300
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38501-4038
Mailing Address - Country:US
Mailing Address - Phone:931-372-2567
Mailing Address - Fax:931-372-2572
Practice Address - Street 1:1080 NEAL ST
Practice Address - Street 2:STE 300
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-4038
Practice Address - Country:US
Practice Address - Phone:931-372-2567
Practice Address - Fax:931-372-2572
Is Sole Proprietor?:No
Enumeration Date:2005-06-10
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNODT2014152W00000X, 152WP0200X, 152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3942934Medicaid
U78852Medicare UPIN
TN3942934Medicaid