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General NPI Number Information
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NPI Number | 1598944654
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Entity Type | Organization
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Legal Business Name | CLARK EYE CARE CENTER
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Dates
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Enumeration Date | 10/25/2007
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Last Update Date | 05/22/2019
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Provider Practice Location Address
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Address Line | 810 NE 25TH AVE
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City | OCALA
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State | FL
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Zip | 34470
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Country | US
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Telephone | 352-732-0046
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Fax |
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Provider Business Mailing Address
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Address Line | 810 NE 25TH AVE
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City | OCALA
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State | FL
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Zip | 34470-6335
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Country | US
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Telephone | 352-732-0046
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MATTHEW J LENTSCH
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Credential | OD
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Telephone | 352-732-0046
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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 | OPC5388
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License Number State | FL
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