# CLEMSON EYE, PA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1447383831
- **Authorized official:** KEVIN BECKER (CFO)
- **Authorized official phone:** (914) 391-4921

## Contact information

- **Practice address:** 360 PELHAM RD, GREENVILLE, SC 29615-3111
- **Practice address phone:** (864) 654-6706
- **Practice address fax:** (864) 292-2020
- **Mailing address:** PO BOX 11407, BIRMINGHAM, AL 35246-8575
- **Mailing address phone:** (864) 359-1308
- **Mailing address fax:** (239) 496-3939

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 152W00000X | Optometrist | 17209 | SC | Yes |
| 207W00000X | Ophthalmology Physician | 17209 | SC | Yes |

## Other

- **Enumeration date:** 03/14/2007
- **Last updated:** 04/28/2026

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1252210001 | DMERC MAC SUPPLIER ID | SC |
| 01 | — | 9429296 | MULTIPLAN GROUP | SC |
| 01 | — | CH3387 | MEDICARE RAILROAD GROUP | SC |
| 05 | — | DA9729 | — | SC |
| 05 | — | PA1747 | — | SC |