Provider Demographics
NPI:1376662890
Name:CLEM, RICHARD NEILL (OD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:NEILL
Last Name:CLEM
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:124 LAKE FOREST SHORES DR
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71913-8993
Mailing Address - Country:US
Mailing Address - Phone:501-318-9236
Mailing Address - Fax:501-625-7777
Practice Address - Street 1:1629 AIRPORT RD
Practice Address - Street 2:SUITE C
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71913-7951
Practice Address - Country:US
Practice Address - Phone:501-767-0602
Practice Address - Fax:501-767-5282
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2017-03-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AR2247152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR102397722Medicaid
AR102397722Medicaid
AR102397722Medicaid