Provider Demographics
NPI:1285776906
Name:CLEMENS, THOMAS A (OD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:A
Last Name:CLEMENS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4800 KERRIA CT
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46033-3989
Mailing Address - Country:US
Mailing Address - Phone:317-843-0413
Mailing Address - Fax:
Practice Address - Street 1:1615 U.S. 231 SOUTH
Practice Address - Street 2:
Practice Address - City:CRAWFORDSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47933
Practice Address - Country:US
Practice Address - Phone:765-362-7982
Practice Address - Fax:765-362-7352
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002108B152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
INT34544Medicare UPIN
IN807980Medicare ID - Type Unspecified