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General NPI Number Information
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NPI Number | 1265581771
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Entity Type | Organization
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Legal Business Name | WESLEY R CLARK, OD & NICOLE L MEERPOHL, OD
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Dates
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Enumeration Date | 01/10/2007
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Last Update Date | 08/27/2008
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Provider Practice Location Address
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Address Line | 111 W 4TH ST
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City | HOLTON
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State | KS
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Zip | 66436-1701
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Country | US
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Telephone | 785-364-4183
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Fax | 785-364-2088
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Provider Business Mailing Address
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Address Line | 111 W 4TH ST
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City | HOLTON
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State | KS
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Zip | 66436-1701
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Country | US
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Telephone | 785-364-4183
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Fax | 785-364-2088
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. SHARON J BOWSER
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Credential |
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Telephone | 785-364-4183
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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 | 1146-3
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License Number State | KS
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 1556
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License Number State | KS
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