Provider Demographics
NPI:1720001035
Name:CLEMENT, ARDIS M (OD)
Entity Type:Individual
Prefix:DR
First Name:ARDIS
Middle Name:M
Last Name:CLEMENT
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:713 WASHINGTON RD
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15228-2001
Mailing Address - Country:US
Mailing Address - Phone:412-561-1964
Mailing Address - Fax:412-561-7295
Practice Address - Street 1:713 WASHINGTON RD
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15228-2001
Practice Address - Country:US
Practice Address - Phone:412-561-1964
Practice Address - Fax:412-561-7295
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOE007731P152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAU66475Medicare UPIN