Provider Demographics
NPI:1972514008
Name:CKODRE, CLAYTON K (OD)
Entity Type:Individual
Prefix:DR
First Name:CLAYTON
Middle Name:K
Last Name:CKODRE
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 1:20630 STATE HIGHWAY 46 W STE 120
Mailing Address - Street 2:
Mailing Address - City:SPRING BRANCH
Mailing Address - State:TX
Mailing Address - Zip Code:78070-6855
Mailing Address - Country:US
Mailing Address - Phone:830-980-3306
Mailing Address - Fax:
Practice Address - Street 1:20630 STATE HIGHWAY 46 W STE 120
Practice Address - Street 2:
Practice Address - City:SPRING BRANCH
Practice Address - State:TX
Practice Address - Zip Code:78070-6855
Practice Address - Country:US
Practice Address - Phone:830-980-3306
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2013-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4442TG152W00000X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX019316101Medicaid
TX00E34SMedicare ID - Type Unspecified
TX019316101Medicaid