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General NPI Number Information
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NPI Number | 1720507312
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Entity Type | Organization
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Legal Business Name | CLARK FAMILY EYE CARE, PLLC
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Dates
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Enumeration Date | 09/14/2017
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Last Update Date | 05/20/2021
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Provider Practice Location Address
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Address Line | 11511 INDEPENDENCE PARKWAY SUITE 102
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City | FRISCO
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State | TX
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Zip | 75035
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Country | US
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Telephone | 972-478-0500
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Fax |
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Provider Business Mailing Address
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Address Line | 11511 INDEPENDENCE PKWY STE 102
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City | FRISCO
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State | TX
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Zip | 75035-4676
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Country | US
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Telephone | 972-478-0550
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Fax |
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Authorized Official
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Title or Position | OWNER/OPTOMETRIST
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Name | KARI CLARK
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Credential | OD
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Telephone | 972-478-0550
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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 | 6066TG
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License Number State | TX
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