Provider Demographics
NPI:1720393507
Name:CASHEN, CLAYTON T (OD)
Entity type:Individual
Prefix:DR
First Name:CLAYTON
Middle Name:T
Last Name:CASHEN
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 549
Mailing Address - Street 2:
Mailing Address - City:WABASH
Mailing Address - State:IN
Mailing Address - Zip Code:46992-0549
Mailing Address - Country:US
Mailing Address - Phone:260-569-9550
Mailing Address - Fax:260-569-9244
Practice Address - Street 1:4023 RED ARROW HWY
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MI
Practice Address - Zip Code:49085-9209
Practice Address - Country:US
Practice Address - Phone:269-983-3200
Practice Address - Fax:269-983-4902
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-17
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18003655A152W00000X
MI4901005099152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200993910Medicaid
INM400024764Medicare PIN
INM400024763Medicare PIN
IN200993910Medicaid
INP00869964Medicare PIN