Provider Demographics
NPI:1750573945
Name:WESLEY D CLEMENT MD PC
Entity type:Organization
Organization Name:WESLEY D CLEMENT MD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OPHTHALMOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:WESLEY
Authorized Official - Middle Name:DOBBS
Authorized Official - Last Name:CLEMENT
Authorized Official - Suffix:SR
Authorized Official - Credentials:MD
Authorized Official - Phone:704-510-3100
Mailing Address - Street 1:230 E WT HARRIS BLVD
Mailing Address - Street 2:SUITE C13
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-3539
Mailing Address - Country:US
Mailing Address - Phone:704-510-3100
Mailing Address - Fax:704-503-1954
Practice Address - Street 1:230 E WT HARRIS BLVD
Practice Address - Street 2:SUITE C13
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-3539
Practice Address - Country:US
Practice Address - Phone:704-510-3100
Practice Address - Fax:704-503-1954
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-13
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC19789156FX1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1100XEye and Vision Services ProvidersTechnician/TechnologistOphthalmicGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8922985Medicaid
NC8922985Medicaid