Terry Lee Clayville, O.D.
Individual provider Active NPI Optometrist · Highland, CA
NPI 1649354432 · NPPES record last updated May 2, 2012
Key facts
- NPI
- 1649354432
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- 08157 (CA)
- Practice address
- 7291 Boulder Ave
Ste 2D
Highland, CA 92346-3389 - Phone
- (909) 425-1212
- Fax
- (909) 425-2485
- NPI assigned
- Oct 25, 2006
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
- Opted out of Medicare
- Yes, effective Oct 1, 2019 through Oct 1, 2027
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 08157 | CA | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Highland Optometrics | Optometrist | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 08157 | CA | Yes |
Addresses
Primary practice location
7291 Boulder Ave
Ste 2D
Highland, CA 92346-3389
Mailing address
7291 Boulder Ave
Ste 2D
Highland, CA 92346-3389
Phone (909) 425-1212
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| SD0081570 | Medicaid | CA |
Other providers in Highland, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 2, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Opt Out Affidavits (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.