Clement Enorense Idehen, O.D

Primary specialty

Corneal and Contact Management OptometristTaxonomy code 152WC0802X

License

VUT006065 Issued in NY

Practice address

5546 Myrtle Ave
Ridgewood, NY 11385-3554

Phone

(718) 628-9200

Fax

(718) 628-5600

NPI assigned

Oct 17, 2007

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Clement Idehen Optometrist PC

  • Optometrist
  • Ridgewood, NY
  • NPI 1760435374
  NPD (past) Authorized official
• Eyesite Vision III Incorporation

  • Optometrist
  • Brooklyn, NY
  • NPI 1891722138
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1192579200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1192579200000",
    "number": "1700075595",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5546 MYRTLE AVE",
            "city": "RIDGEWOOD",
            "state": "NY",
            "postal_code": "113853554",
            "telephone_number": "718-628-9200",
            "fax_number": "718-628-5600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5546 MYRTLE AVE",
            "city": "RIDGEWOOD",
            "state": "NY",
            "postal_code": "113853554",
            "telephone_number": "718-628-9200",
            "fax_number": "718-628-5600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IDEHEN",
        "first_name": "CLEMENT",
        "middle_name": "ENORENSE",
        "name_prefix": "Dr.",
        "credential": "O.D",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-10-17",
        "last_updated": "2007-10-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NY",
            "license": "T006065",
            "primary": false
        },
        {
            "code": "152WC0802X",
            "taxonomy_group": "",
            "desc": "Optometrist, Corneal and Contact Management",
            "state": "NY",
            "license": "VUT006065",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Corneal and Contact Management Optometrist in Ridgewood, NY
• Providers in Ridgewood, NY by specialty
• Corneal and Contact Management Optometrist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.