Provider Demographics
NPI:1174556344
Name:TWITERO, CLAYTON PAUL (OD)
Entity type:Individual
Prefix:DR
First Name:CLAYTON
Middle Name:PAUL
Last Name:TWITERO
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:606 20TH ST S
Mailing Address - Street 2:
Mailing Address - City:BROOKINGS
Mailing Address - State:SD
Mailing Address - Zip Code:57006-4671
Mailing Address - Country:US
Mailing Address - Phone:605-627-1212
Mailing Address - Fax:605-627-1313
Practice Address - Street 1:606 20TH ST S
Practice Address - Street 2:
Practice Address - City:BROOKINGS
Practice Address - State:SD
Practice Address - Zip Code:57006-4671
Practice Address - Country:US
Practice Address - Phone:605-627-1212
Practice Address - Fax:605-627-1313
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDT477152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD6855Medicare PIN
SD3894920001Medicare NSC