Provider Demographics
NPI:1619966991
Name:CLEMENT, PAUL A (OD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:A
Last Name:CLEMENT
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:PO BOX 425A
Mailing Address - Street 2:
Mailing Address - City:DU BOIS
Mailing Address - State:PA
Mailing Address - Zip Code:15801-0425
Mailing Address - Country:US
Mailing Address - Phone:814-771-6353
Mailing Address - Fax:814-238-0898
Practice Address - Street 1:2901 E COLLEGE AVE
Practice Address - Street 2:SUITE 976
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16801-7577
Practice Address - Country:US
Practice Address - Phone:814-234-3047
Practice Address - Fax:814-238-0898
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-19
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000756152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAOEG000756OtherLICENSE
PA0005458970007Medicaid
PA0005458970007Medicaid
MC0417421OtherDEA
PAOEG000756OtherLICENSE