MEDICARE: DR. SUSAN CHRISTINA MISHOCK-CLAPPER O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	OEG001425	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MI964347	OTHER	PA	BLUE CROSS BLUE SHEILD
3	PA8077	OTHER	PA	EYEMED VISION CARE
4	DA50984	OTHER	PA	DAVIS VISION

General Provider Information

NPI Number	:	1225091861
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUSAN CHRISTINA MISHOCK-CLAPPER O.D.

Provider Business Mailing Address
First Line	:	635 WALDO ST
Second Line	:
City	:	GALLITZIN
State	:	PA
Zip	:	16641-2106
Country	:	US
Telephone Number	:	814-884-2967
Fax Number	:

Provider Business Practice Location Address
First Line	:	926 LOGAN VALLEY MALL
Second Line	:
City	:	ALTOONA
State	:	PA
Zip	:	16602-2832
Country	:	US
Telephone Number	:	814-942-3225
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/06/2006
Last Update Date	:	07/08/2007

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