Healthcare Provider Details

I. General information

NPI: 1972507614
Provider Name (Legal Business Name): JASON C CLOPTON O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2005
Last Update Date: 02/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1080 NEAL ST STE 300
COOKEVILLE TN
38501-4038
US

IV. Provider business mailing address

1080 NEAL ST STE 300
COOKEVILLE TN
38501-4038
US

V. Phone/Fax

Practice location:
  • Phone: 931-372-2567
  • Fax: 931-372-2572
Mailing address:
  • Phone: 931-372-2567
  • Fax: 931-372-2572

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberODT2014
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License NumberODT2014
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License NumberODT2014
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: