Individual
DALE S CLEMENS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
824 FRANKLIN PARK DR, EAST SYRACUSE, NY 13057-1614
(315) 446-1288
(315) 463-2210
Mailing address
824 FRANKLIN PARK DR, EAST SYRACUSE, NY 13057-1614
(315) 446-1288
(315) 463-2210
Taxonomy
Speciality
Code
Description
License number
State
156FC0801X
Contact Lens Fitter
C006828
NY
156FX1800X
Optician
Primary
C006828
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
C006828
OPHTHALMIC DISPENSING LIC
NY
01
—
NY6828
EYEMED PROVIDER NUMBER
NY
Enumeration date
01/02/2007
Last updated
06/27/2011
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