Clayton, Ethan M

Clayton, Ethan M is an individual health care provider with primary practice located at 23000 Atlantic Circle , Moreno Valley CA 92553-5229. He recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as his primary health care specialty. Clayton, Ethan M can be contacted via phone (951) 924-1877.

Contact Information

Primary practice address
23000 Atlantic Circle Moreno Valley CA 92553-5229
Phone: (951) 924-1877
Fax: (951) 485-3580
Website:
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Health care specialties

SpecialtyCodeLicense #State
Eye and Vision Services Providers / Optometrist 152W00000X 12701T California

Profile Details

NPI number 1629130257
LBN Legal business name Clayton, Ethan M
Credentials Doctor of Optometry (OD)
Entity Individual
Sole proprietor 1 No
Enumeration date Dec 13th, 2006
Last updated Jan 18th, 2013 - about 11 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1629130257 NPPES
California MEDICAID SD0093410

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