Provider Demographics
NPI:1619966504
Name:CLANCY, STEVEN PATRICK (OD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:PATRICK
Last Name:CLANCY
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 1:9475A BRIAR VILLAGE PT
Mailing Address - Street 2:SUITE 200
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-7902
Mailing Address - Country:US
Mailing Address - Phone:719-594-2020
Mailing Address - Fax:719-694-8562
Practice Address - Street 1:9475A BRIAR VILLAGE PT
Practice Address - Street 2:SUITE 200
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-7902
Practice Address - Country:US
Practice Address - Phone:719-594-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-14
Last Update Date:2014-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2116152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
292842YSWBMedicare UPIN