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Organization
OPTOMETRIC CENTERS
Active
Organization
OPTOMETRIC CENTERS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ETHAN M CLAYTON O.D. (OPTOMOTRIST)
(951) 924-1877
Entity
Organization
Contact information
Practice address
12968 FREDERICK ST STE A, MORENO VALLEY, CA 92553-5229
(951) 924-1877
(951) 485-3580
Mailing address
12968 FREDERICK ST, MORENO VALLEY, CA 92553-5229
(951) 924-1877
(951) 485-3580
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
12701T
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
SD0093410
—
CA
Enumeration date
05/21/2007
Last updated
08/22/2020
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