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General NPI Number Information
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NPI Number | 1447383831
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Entity Type | Organization
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Legal Business Name | CLEMSON EYE, PA
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Dates
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Enumeration Date | 03/14/2007
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Last Update Date | 02/06/2025
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Provider Practice Location Address
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Address Line | 360 PELHAM RD
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City | GREENVILLE
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State | SC
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Zip | 29615-3111
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Country | US
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Telephone | 864-654-6706
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Fax | 864-292-2020
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Provider Business Mailing Address
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Address Line | PO BOX 896189
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City | CHARLOTTE
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State | NC
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Zip | 28289-6189
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Country | US
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Telephone | 864-654-6706
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | KEVIN S BECKER
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Credential |
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Telephone | 706-243-2259
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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 | 17209
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License Number State | SC
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