Provider Demographics
NPI:1750437067
Name:BRISCOE, CLAYTON M (OD)
Entity type:Individual
Prefix:DR
First Name:CLAYTON
Middle Name:M
Last Name:BRISCOE
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 1:1815 SW EMIGRANT AVE
Mailing Address - Street 2:
Mailing Address - City:PENDLETON
Mailing Address - State:OR
Mailing Address - Zip Code:97801-1843
Mailing Address - Country:US
Mailing Address - Phone:541-276-3653
Mailing Address - Fax:541-966-4322
Practice Address - Street 1:1815 SW EMIGRANT AVE
Practice Address - Street 2:
Practice Address - City:PENDLETON
Practice Address - State:OR
Practice Address - Zip Code:97801-1843
Practice Address - Country:US
Practice Address - Phone:541-276-3653
Practice Address - Fax:541-966-4322
Is Sole Proprietor?:No
Enumeration Date:2007-01-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2399ATI152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR047329Medicaid
OR047329Medicaid
R106857Medicare ID - Type Unspecified