Provider Demographics
NPI:1861803124
Name:CLEMMONS FAMILY EYE CARE
Entity type:Organization
Organization Name:CLEMMONS FAMILY EYE CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING AND INSURANCE SPECIALIST
Authorized Official - Prefix:MS
Authorized Official - First Name:RENEE'
Authorized Official - Middle Name:
Authorized Official - Last Name:OSBORNE
Authorized Official - Suffix:
Authorized Official - Credentials:MA, AAMA
Authorized Official - Phone:336-766-7373
Mailing Address - Street 1:PO BOX 127
Mailing Address - Street 2:6301 STADIUM DRIVE
Mailing Address - City:CLEMMONS
Mailing Address - State:NC
Mailing Address - Zip Code:27012
Mailing Address - Country:US
Mailing Address - Phone:336-766-7373
Mailing Address - Fax:
Practice Address - Street 1:6301 STADIUM DR
Practice Address - Street 2:
Practice Address - City:CLEMMONS
Practice Address - State:NC
Practice Address - Zip Code:27012-8766
Practice Address - Country:US
Practice Address - Phone:336-766-7373
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-08
Last Update Date:2014-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1020152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty