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General NPI Number Information
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NPI Number | 1902699499
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Entity Type | Individual
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Provider Name | NICOLE CLARK LDO
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Gender | Female
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Dates
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Enumeration Date | 05/27/2025
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Last Update Date | 05/27/2025
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Provider Practice Location Address
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Address Line | 3950 W LAKE MEAD BLVD
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City | NORTH LAS VEGAS
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State | NV
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Zip | 89032-4895
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Country | US
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Telephone | 702-631-8472
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Fax | 702-631-9417
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Provider Business Mailing Address
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Address Line | 8137 REDBUD VINE ST
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City | NORTH LAS VEGAS
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State | NV
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Zip | 89085-4456
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Country | US
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Telephone | 707-758-3386
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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 | 156FX1800X
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Taxonomy Name | Optician
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License Number | 527
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License Number State | NV
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