Provider Demographics
NPI:1629686373
Name:CLEMSON EYE, PA
Entity Type:Organization
Organization Name:CLEMSON EYE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:LANITA
Authorized Official - Middle Name:
Authorized Official - Last Name:WEISENBERGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-722-1133
Mailing Address - Street 1:15 SOUTHERN CENTER CT
Mailing Address - Street 2:
Mailing Address - City:EASLEY
Mailing Address - State:SC
Mailing Address - Zip Code:29642-1533
Mailing Address - Country:US
Mailing Address - Phone:864-654-6706
Mailing Address - Fax:864-343-2074
Practice Address - Street 1:504 S 4TH ST
Practice Address - Street 2:
Practice Address - City:HARTSVILLE
Practice Address - State:SC
Practice Address - Zip Code:29550-5720
Practice Address - Country:US
Practice Address - Phone:864-654-6706
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-20
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty