Individual provider Active NPI

John R Clasen Jr., O.D.

  • Optometrist
  • Birmingham, AL
National Provider Identifier
1780649707
Registry record updated Feb 24, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
S-839-TA-366 Issued in AL
Practice address
840 Montclair Rd
Suite 722
Birmingham, AL 35213-1920
Phone
(205) 591-2311
Fax
(205) 592-3531
NPI assigned
Apr 20, 2006
Last updated
Feb 24, 2017By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 24, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X S-839-TA-366 AL Primary

Addresses

Primary practice location

840 Montclair Rd
Suite 722
Birmingham, AL 35213-1920

Mailing address

230 E 10TH St
Suite 106
Anniston, AL 36207-5784
Phone (256) 741-7340

Other identifiers 1

IdentifierTypeStateIssuer
009911178MedicaidAL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL
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

Enrollment IDStateProvider typePAC IDDetails
I20170404000390 AL Order and Referring Only - OptometryPractitioner - Optometry 5395846778

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Ophthalmology Assoc P.C. Past Accepting new patients

Organizations & group practices 1

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

NPI Registry JSON

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

{
    "created_epoch": "1145491200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1487894400000",
    "number": "1780649707",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "230 E 10TH ST",
            "address_2": "SUITE 106",
            "city": "ANNISTON",
            "state": "AL",
            "postal_code": "362075784",
            "telephone_number": "256-741-7340",
            "fax_number": "256-741-7373"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "840 MONTCLAIR RD",
            "address_2": "SUITE 722",
            "city": "BIRMINGHAM",
            "state": "AL",
            "postal_code": "352131920",
            "telephone_number": "205-591-2311",
            "fax_number": "205-592-3531"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLASEN",
        "first_name": "JOHN",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-20",
        "last_updated": "2017-02-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "AL",
            "license": "S-839-TA-366",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "009911178",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Birmingham, AL

Sources for this page

Verify at the official NPI Registry.