Provider Demographics
NPI:1699863175
Name:MCDUFFIE, CLEM DONALD (OD)
Entity type:Individual
Prefix:DR
First Name:CLEM
Middle Name:DONALD
Last Name:MCDUFFIE
Suffix:
Gender:M
Credentials:OD
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Other - Credentials:
Mailing Address - Street 1:4500 STUART STREET
Mailing Address - Street 2:MACH, ATTN: MCXL-PQ (CREDENTIALS)
Mailing Address - City:FORT JACKSON
Mailing Address - State:SC
Mailing Address - Zip Code:29207-5720
Mailing Address - Country:US
Mailing Address - Phone:803-751-2618
Mailing Address - Fax:803-751-2689
Practice Address - Street 1:4500 STUART STREET
Practice Address - Street 2:MACH, ATTN: MCXL-PQ (CREDENTIALS)
Practice Address - City:FORT JACKSON
Practice Address - State:SC
Practice Address - Zip Code:29207-5720
Practice Address - Country:US
Practice Address - Phone:803-751-2618
Practice Address - Fax:803-751-2689
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1528152W00000X
TX3729T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCVAD 000Medicare UPIN