Provider Demographics
NPI:1801848544
Name:CLEMENTS, STEVEN DON (OD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:DON
Last Name:CLEMENTS
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 1:421 N COLE RD # 102
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-9114
Mailing Address - Country:US
Mailing Address - Phone:208-685-0416
Mailing Address - Fax:208-685-0418
Practice Address - Street 1:421 N COLE RD # 102
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-9114
Practice Address - Country:US
Practice Address - Phone:208-685-0416
Practice Address - Fax:208-685-0418
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDODP669152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000308300Medicaid
ID1591640Medicare ID - Type UnspecifiedFAIRVIEW LOCATION