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Individual

DR. CLEMENT ENORENSE IDEHEN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
O.D

Contact information

Practice address
5546 MYRTLE AVE, RIDGEWOOD, NY 11385-3554
(718) 628-9200
(718) 628-5600
Mailing address
5546 MYRTLE AVE, RIDGEWOOD, NY 11385-3554
(718) 628-9200
(718) 628-5600

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
T006065
NY
152WC0802X
Corneal and Contact Management Optometrist
Primary
VUT006065
NY

Other

Enumeration date
10/17/2007
Last updated
10/17/2007
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