Organization
CLEMENT IDEHEN OPTOMETRIST PC
Active
Other names
eyesite vision center
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CLEMENT ENORENSE IDEHEN O.D (PRESIDENT)
(718) 628-9200
Entity
Organization
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
Primary
T006065
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02263261
—
NY
Enumeration date
05/18/2006
Last updated
09/16/2009
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