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 1:50 YORKTOWN SHOPPING CTR UNIT 315
Mailing Address - Street 2:
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-5631
Mailing Address - Country:US
Mailing Address - Phone:305-302-7937
Mailing Address - Fax:
Practice Address - Street 1:1601 E 80TH AVE
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-5737
Practice Address - Country:US
Practice Address - Phone:219-750-9673
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-14
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18004459A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist