Provider Demographics
NPI:1194719674
Name:RHODES, CLAYTON B (OD)
Entity type:Individual
Prefix:
First Name:CLAYTON
Middle Name:B
Last Name:RHODES
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 1:5433 HIXSON PIKE
Mailing Address - Street 2:
Mailing Address - City:HIXSON
Mailing Address - State:TN
Mailing Address - Zip Code:37343-3238
Mailing Address - Country:US
Mailing Address - Phone:423-843-2020
Mailing Address - Fax:423-842-1914
Practice Address - Street 1:5433 HIXSON PIKE
Practice Address - Street 2:
Practice Address - City:HIXSON
Practice Address - State:TN
Practice Address - Zip Code:37343-3238
Practice Address - Country:US
Practice Address - Phone:423-843-2020
Practice Address - Fax:423-842-1914
Is Sole Proprietor?:No
Enumeration Date:2005-09-09
Last Update Date:2014-10-06
Deactivation Date:2006-03-25
Deactivation Code:
Reactivation Date:2006-03-29
Provider Licenses
StateLicense IDTaxonomies
TNOD507152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0400520001OtherMEDICARE, DME MAC
TN3593471Medicare PIN
TN0400520001OtherMEDICARE, DME MAC