Provider Demographics
NPI:1780666966
Name:CLEMENT, MARK E (OD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:E
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 1:603 STANWIX ST
Mailing Address - Street 2:SUITE 150
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15222-1425
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:603 STANWIX ST
Practice Address - Street 2:SUITE 150
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15222-1425
Practice Address - Country:US
Practice Address - Phone:412-471-9838
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-15
Last Update Date:2014-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG-354152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA243765701OtherUNITED HEALTHCARE
PA2521779OtherAETNA HMO
PA397168OtherNATIONAL VISION ADMIN.
PAU82201OtherHEALTH AMERICA
PA220087OtherUPMC
PA7456187OtherAETNA PPO
PAPA355OtherVBA
PA1342958OtherBLUE CROSS/BLUE SHIELD
PA6621OtherDAVIS VISION
PACL913321OtherCLARITY VISION
PA243765701OtherUNITED HEALTHCARE
PAPA355OtherVBA