Provider Demographics
NPI:1366514028
Name:CLEMENTS, JOSEPH EDGAR III (OCULARIST)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:EDGAR
Last Name:CLEMENTS
Suffix:III
Gender:M
Credentials:OCULARIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3419 S COULTER ST STE 2C
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79109-3998
Mailing Address - Country:US
Mailing Address - Phone:806-355-3401
Mailing Address - Fax:
Practice Address - Street 1:3419 S COULTER ST STE 2C
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79109-3998
Practice Address - Country:US
Practice Address - Phone:806-355-3401
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1700XEye and Vision Services ProvidersTechnician/TechnologistOcularist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0665740001Medicare NSC