Organization
CLEMSON OPHTHALMOLOGY
Active
Parent organization
CLEMOSON OPHTHALMOLOGY
Organization subpart
Yes
Provider details
NPI number
Legal business name
CLEMOSON OPHTHALMOLOGY
Authorized official
MICHELLE FISK (ACCOUNTS RECEIVABLE)
(864) 654-6706
Entity
Organization
Contact information
Practice address
931 TIGER BLVD, CLEMSON, SC 29631-1419
(864) 654-6706
(864) 654-3275
Mailing address
P.O. BOX 1666, CLEMSON, SC 29633
(864) 654-6706
(864) 654-3275
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1054
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
DA9729
—
SC
Enumeration date
11/11/2008
Last updated
11/11/2008
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