Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1700X | Ocularist |
NPI | 1366514028 |
---|---|
Provider Name | Mr. Joseph Edgar Clements III |
First Address | Amarillo, TX 79109-3998 |
Second Address | Amarillo, TX 79109-3998 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/11/2006 |
Last Update Date | 09/07/2007 |