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General NPI Number Information
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NPI Number | 1063981900
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Entity Type | Organization
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Legal Business Name | CLARK OPTOMETRIC CENTER OF SC, P.A.
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Dates
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Enumeration Date | 11/21/2018
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Last Update Date | 01/12/2026
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Provider Practice Location Address
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Address Line | 419 SE MAIN ST STE 300
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City | SIMPSONVILLE
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State | SC
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Zip | 29681-2676
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Country | US
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Telephone | 864-417-2345
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Fax | 864-399-4519
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Provider Business Mailing Address
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Address Line | 200 PERIMETER PARK DRIVE UNIT D
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City | MORRISVILLE
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State | NC
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Zip | 27560
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Country | US
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Telephone | 919-544-4097
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Fax | 919-678-3814
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Authorized Official
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Title or Position | CHIEF MEDICAL OFFICER
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Name | MR. ANTHONY R CLARK
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Credential | OD
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Telephone | 919-544-4097
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number |
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License Number State |
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