Provider Demographics
NPI:1659447282
Name:CLEMENS, DANIEL J (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:J
Last Name:CLEMENS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:658 BOULEVARD ST
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:OH
Mailing Address - Zip Code:44622-2027
Mailing Address - Country:US
Mailing Address - Phone:330-364-4434
Mailing Address - Fax:330-364-2729
Practice Address - Street 1:658 BOULEVARD ST
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:OH
Practice Address - Zip Code:44622-2027
Practice Address - Country:US
Practice Address - Phone:330-364-4434
Practice Address - Fax:330-364-2729
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-04-0018-C207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
1417962OtherUMWA
791183479OtherRR
OH0403290Medicaid
000000136254OtherANTHEM
4018930001OtherDMERC
OH0403290Medicaid