Provider Demographics
NPI:1154371037
Name:DEPEW, CLAUDE KENNETH (OD)
Entity type:Individual
Prefix:DR
First Name:CLAUDE
Middle Name:KENNETH
Last Name:DEPEW
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7301 W DESCHUTES AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-7799
Mailing Address - Country:US
Mailing Address - Phone:509-735-2020
Mailing Address - Fax:509-783-2135
Practice Address - Street 1:7301 W DESCHUTES AVE
Practice Address - Street 2:SUITE B
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-7799
Practice Address - Country:US
Practice Address - Phone:509-735-2020
Practice Address - Fax:509-783-2135
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-11
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD00001355152W00000X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAT02279Medicare UPIN
WAG8851008Medicare PIN