Provider Demographics
NPI:1427822014
Name:DENIS, CLARENCE STEPHEN (OD)
Entity type:Individual
Prefix:DR
First Name:CLARENCE
Middle Name:STEPHEN
Last Name:DENIS
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 1:3500 W PETERSON AVE STE 401
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60659-3307
Mailing Address - Country:US
Mailing Address - Phone:773-588-3090
Mailing Address - Fax:
Practice Address - Street 1:3500 W PETERSON AVE STE 401
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60659-3307
Practice Address - Country:US
Practice Address - Phone:773-588-3090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-14
Last Update Date:2025-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18004459A152W00000X
FLOPC6780152W00000X
IL46011839152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist