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General NPI Number Information
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NPI Number | 1598941288
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Entity Type | Individual
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Provider Name | SELMER MEREDITH CLARK OD
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Gender | Male
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Dates
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Enumeration Date | 01/14/2008
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Last Update Date | 01/13/2010
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Provider Practice Location Address
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Address Line | 201 E 3RD AVE S
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City | CAVALIER
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State | ND
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Zip | 58220
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Country | US
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Telephone | 701-265-8315
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Fax | 701-265-8317
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Provider Business Mailing Address
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Address Line | PO BOX 148 201 E 3RD AVE S
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City | CAVALIER
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State | ND
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Zip | 58220-0148
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Country | US
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Telephone | 701-265-8315
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Fax | 701-265-8317
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 358
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License Number State | ND
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