Individual
BRIAN CLEMENTS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
33 W 42ND ST, NEW YORK, NY 10036-8005
(212) 938-4000
Mailing address
3507 32ND ST APT A3, ASTORIA, NY 11106-2748
(516) 503-9146
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
TUV008775
NY
152W00000X
Optometrist
Primary
TUV008775-1
NY
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/21/2018
Last updated
01/23/2019
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