Organization
CLEMSON EYE, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KEVIN BECKER (CFO)
(914) 391-4921
Entity
Organization
Contact information
Practice address
360 PELHAM RD, GREENVILLE, SC 29615-3111
(864) 654-6706
(864) 292-2020
Mailing address
PO BOX 11407, BIRMINGHAM, AL 35246-8575
(864) 359-1308
(239) 496-3939
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
17209
SC
207W00000X
Ophthalmology Physician
Primary
17209
SC
Other
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
Enumeration date
03/14/2007
Last updated
04/28/2026
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