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General NPI Number Information
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NPI Number | 1225087943
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Entity Type | Individual
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Provider Name | CLARENCE DAVID VESELY O.D.
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Gender | Male
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Dates
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Enumeration Date | 05/09/2006
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Last Update Date | 10/01/2008
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Provider Practice Location Address
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Address Line | LANDSTUHL REGIONAL MEDICAL CENTER CMR 402, BOX 2078
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City | APO
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State | AE
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Zip | 09180
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Country | US
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Telephone | 011496371868532
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Fax |
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Provider Business Mailing Address
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Address Line | CMR 402 BOX 2078
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City | APO
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State | AE
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Zip | 09180
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Country | US
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Telephone | 011496371868532
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 3098
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License Number State | WA
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