Provider Demographics
NPI:1487649810
Name:CLAYTON, CHARLES J (OD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:J
Last Name:CLAYTON
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 1:14645 NE BEL RED RD STE 102
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98007-3929
Mailing Address - Country:US
Mailing Address - Phone:425-747-2020
Mailing Address - Fax:425-747-2099
Practice Address - Street 1:14645 NE BEL RED RD STE 102
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98007-3929
Practice Address - Country:US
Practice Address - Phone:425-747-2020
Practice Address - Fax:425-747-2099
Is Sole Proprietor?:No
Enumeration Date:2005-09-12
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA3565152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1374CLOtherREGENCE BLUE SHIELD
WA410045253OtherRAILROAD MEDICARE PIN
WAAB16487Medicare ID - Type UnspecifiedMEDICARE
WAGAB16487Medicare PIN