Provider Demographics
NPI:1104934686
Name:CLAPPER, ROY LAVERN (OD)
Entity type:Individual
Prefix:
First Name:ROY
Middle Name:LAVERN
Last Name:CLAPPER
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:PO BOX 2592
Mailing Address - Street 2:
Mailing Address - City:HAYDEN
Mailing Address - State:ID
Mailing Address - Zip Code:83835-2592
Mailing Address - Country:US
Mailing Address - Phone:208-676-7356
Mailing Address - Fax:208-676-7384
Practice Address - Street 1:355 E NEIDER AVE
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83815-3723
Practice Address - Country:US
Practice Address - Phone:208-676-7356
Practice Address - Fax:208-676-7384
Is Sole Proprietor?:No
Enumeration Date:2006-08-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDODP-796152W00000X
WAOD00003705152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist