Linda Jean Clark
Optometrist
1765 Stafford Court
Goshen
, Indiana 46526-6542
Linda Jean Clark
Optometrist
1765 Stafford Court
Goshen
, Indiana 46526-6542
(574) 534-3479
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About
Features
Specialties
- Optometrist
Languages spoken
- English
Location
First Address
- Linda Jean Clark
- 1765 Stafford Court
- Goshen, IN
- Zip : 46526-6542
- Fax : (574) 534-3479
- Phone : (574) 533-4910
Second Address
- Linda Jean Clark
- 1765 Stafford Court
- Goshen, IN
- Zip : 46526-6542
- Fax : (574) 534-3479
- Phone : (574) 533-4910
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 152W00000X | Optometrist | 18002119 | IN |
National Provider Identifier
| NPI | 1013061803 |
|---|---|
| Provider Name | Linda Jean Clark |
| First Address | Goshen, IN 46526-6542 |
| Second Address | Goshen, IN 46526-6542 |
| Gender | F |
| NPI Entity type | Individual |
| Is Sole Proprietor | Yes |
| Is Organization Subpart | N/A |
| Enumeration Date | 22/01/2007 |
| Last Update Date | 02/02/2015 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| 100112880A | (05) | IN |
| T69258 | (02) |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.