Ethan M Clayton, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

12701T Issued in CA

Practice address

23000 Atlantic Circle
Moreno Valley, CA 92553-5229

Phone

(951) 924-1877

Fax

(951) 485-3580

NPI assigned

Dec 13, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Optometry

Education

Southern California College of Optometry, 2004

Medicare assignment

May accept Medicare assignment

Group practices

Ragsdale and Clayton Optometric Centers IncGroup PAC ID 9537381132, 3 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Ragsdale & Clayton Optometric Centers, Inc.

  dba Optometric Centers

  • Optometrist
  • Moreno Valley, CA
  • NPI 1770901613
  Medicare reassignment Care Compare group NPD Authorized official
• Ho Young Cho Optometric Corporation

  dba Hip Optics Optometry

  • Optometrist
  • Riverside, CA
  • NPI 1578916276
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1165968000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1358467200000",
    "number": "1629130257",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23000 ATLANTIC CIR",
            "city": "MORENO VALLEY",
            "state": "CA",
            "postal_code": "925535990",
            "telephone_number": "951-924-1877",
            "fax_number": "951-485-3580"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23000 ATLANTIC CIRCLE",
            "city": "MORENO VALLEY",
            "state": "CA",
            "postal_code": "925535229",
            "telephone_number": "951-924-1877",
            "fax_number": "951-485-3580"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLAYTON",
        "first_name": "ETHAN",
        "middle_name": "M",
        "name_prefix": "Mr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-13",
        "last_updated": "2013-01-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "12701T",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "SD0093410",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Shauna Churchill
• Geyli Cifuentes
• Lysa Cimicato, DPT
• Lois Chen Clarkson, NP
• James Lamar Claybon
• Cherry Winnifred Clement, RN
• Douglas Michael Clements, D.O.
• Josh Lee Cleope
• Janean Marie Cleveland
• Christy Clever, M.S.W.

• Optometrist in Moreno Valley, CA
• Providers in Moreno Valley, CA by specialty
• Optometrist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.