Provider Demographics
NPI:1306914726
Name:CLAYTON-JETER, HELENE D (OD)
Entity type:Individual
Prefix:DR
First Name:HELENE
Middle Name:D
Last Name:CLAYTON-JETER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:HELENE
Other - Middle Name:DENISE
Other - Last Name:CLAYTON JETER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2101 EAST JEFFERSON STREET
Mailing Address - Street 2:PPQA MEDICARE COMPLIANCE UNIT 6 WEST
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-4908
Mailing Address - Country:US
Mailing Address - Phone:301-816-6660
Mailing Address - Fax:301-816-6308
Practice Address - Street 1:11445 SUNSET HILLS ROAD
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-5276
Practice Address - Country:US
Practice Address - Phone:703-709-1748
Practice Address - Fax:703-709-1711
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA1043152W00000X
GAOPT003499152W00000X
FLTPOP152152W00000X
VA0618000630152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U36766Medicare UPIN
012074M92Medicare ID - Type Unspecified