Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 152W00000X | Optometrist | OET008802 | PA |
N | 152WC0802X | Optomitrist - Corneal and Contact Lenses | OET008802 | PA |
NPI | 1013011568 |
---|---|
Provider Name | Dr. David M. Clark |
First Address | Berwick, PA 18603-1334 |
Second Address | Bloomsburg, PA 17815-8330 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/09/2006 |
Last Update Date | 08/07/2007 |