Provider Demographics
NPI:1952337008
Name:CLAY STREET EYECARE P.C.
Entity Type:Organization
Organization Name:CLAY STREET EYECARE P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:G
Authorized Official - Last Name:BUECHLER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:812-482-2195
Mailing Address - Street 1:501 CLAY ST
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:IN
Mailing Address - Zip Code:47546-3125
Mailing Address - Country:US
Mailing Address - Phone:812-482-2195
Mailing Address - Fax:812-634-6620
Practice Address - Street 1:501 CLAY ST
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:IN
Practice Address - Zip Code:47546-3125
Practice Address - Country:US
Practice Address - Phone:812-482-2195
Practice Address - Fax:812-634-6620
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-23
Last Update Date:2008-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN56000361A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN5799880001Medicare NSC