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NPI Code Detail

MEDICARE: JOHN K CLEMENTS O.D.

MEDICARE:   JOHN K CLEMENTS  O.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometrist126TWY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1346337847
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOHN K CLEMENTS O.D.
Provider Business Mailing Address
First Line : 1421 S BEVERLY ST
Second Line :
City : CASPER
State : WY
Zip : 82609-4131
Country : US
Telephone Number : 307-237-6025
Fax Number : 307-237-6025
Provider Business Practice Location Address
First Line : 1421 S BEVERLY ST
Second Line :
City : CASPER
State : WY
Zip : 82609-4131
Country : US
Telephone Number : 307-237-6025
Fax Number : 307-237-6025
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/06/2006
Last Update Date : 02/03/2020

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