Healthcare Provider Details

I. General information

NPI: 1427822014
Provider Name (Legal Business Name): CLARENCE STEPHEN DENIS OD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2023
Last Update Date: 09/30/2025
Certification Date: 09/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 W PETERSON AVE STE 401
CHICAGO IL
60659-3307
US

IV. Provider business mailing address

3500 W PETERSON AVE STE 401
CHICAGO IL
60659-3307
US

V. Phone/Fax

Practice location:
  • Phone: 773-588-3090
  • Fax:
Mailing address:
  • Phone: 773-588-3090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number18004459A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPC6780
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number46011839
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: