MEDICARE: DANIEL PAUL CLOUSING 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	OPT-2654	CO

General Provider Information

NPI Number	:	1225299407
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL PAUL CLOUSING O.D.

Provider Business Mailing Address
First Line	:	18488 KEYSER CREEK AVE
Second Line	:
City	:	PARKER
State	:	CO
Zip	:	80134-7670
Country	:	US
Telephone Number	:	616-446-0041
Fax Number	:

Provider Business Practice Location Address
First Line	:	210 ELIZABETH ST
Second Line	:	SUITE 'B'
City	:	ELIZABETH
State	:	CO
Zip	:	80107-7538
Country	:	US
Telephone Number	:	303-646-8888
Fax Number	:	303-646-8880

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

Provider Enumeration Date	:	06/20/2008
Last Update Date	:	03/13/2009

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