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General NPI Number Information
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NPI Number | 1750449252
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Entity Type | Individual
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Provider Name | KATHRYN M CLARK OD
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Gender | Female
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Dates
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Enumeration Date | 12/05/2006
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Last Update Date | 05/04/2011
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Provider Practice Location Address
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Address Line | 2101 JACOB ST. SUITE 201 VALLEY PROF. CENTER SOUTH
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City | WHEELING
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State | WV
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Zip | 26003-6390
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Country | US
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Telephone | 304-242-9245
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Fax | 304-242-6870
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Provider Business Mailing Address
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Address Line | 617 GLENHITE AVE
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City | WHEELING
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State | WV
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Zip | 26003-6611
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Country | US
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Telephone | 304-233-1482
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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 | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 831-OD
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License Number State | WV
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