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General NPI Number Information
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NPI Number | 1689015075
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Entity Type | Individual
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Provider Name | MELANIE DAWN CLARK O.D.
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Gender | Female
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Dates
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Enumeration Date | 07/12/2013
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Last Update Date | 07/09/2025
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Provider Practice Location Address
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Address Line | 3363 MERLIN DR
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City | IDAHO FALLS
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State | ID
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Zip | 83404-7405
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Country | US
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Telephone | 208-523-0330
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Fax | 208-534-9997
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Provider Business Mailing Address
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Address Line | 128 N 4010 E
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City | RIGBY
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State | ID
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Zip | 83442-5787
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Country | US
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Telephone | 208-351-6616
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Fax |
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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 | 224P00000X
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Taxonomy Name | Prosthetist
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License Number |
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License Number State |
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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 | ODP-100278
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License Number State | ID
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