Provider Demographics
NPI:1821028192
Name:COLMENARES-PASCUAL, CLARA (OD)
Entity Type:Individual
Prefix:DR
First Name:CLARA
Middle Name:
Last Name:COLMENARES-PASCUAL
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 1:43 DOBBS FERRY RD
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10607-2058
Mailing Address - Country:US
Mailing Address - Phone:914-683-8026
Mailing Address - Fax:
Practice Address - Street 1:110 DYCKMAN ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10040-1001
Practice Address - Country:US
Practice Address - Phone:212-567-6789
Practice Address - Fax:212-304-1184
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006170152WX0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WX0102XEye and Vision Services ProvidersOptometristOccupational Vision
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01997608Medicaid
NYC59631Medicare ID - Type Unspecified