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General NPI Number Information
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NPI Number | 1548432156
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Entity Type | Organization
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Legal Business Name | GARY L. CLARKE, INC.
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Dates
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Enumeration Date | 03/24/2008
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Last Update Date | 04/09/2008
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Provider Practice Location Address
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Address Line | 308 SILVER BRIDGE PLZ
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City | GALLIPOLIS
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State | OH
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Zip | 45631-1833
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Country | US
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Telephone | 740-446-2525
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Fax | 740-446-4371
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Provider Business Mailing Address
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Address Line | 308 SILVER BRIDGE PLZ
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City | GALLIPOLIS
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State | OH
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Zip | 45631-1833
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Country | US
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Telephone | 740-446-2525
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Fax | 740-446-4371
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GARY L CLARKE
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Credential | O.D.
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Telephone | 740-446-2525
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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 | 3220
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License Number State | OH
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