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General NPI Number Information
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NPI Number | 1982865879
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Entity Type | Organization
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Legal Business Name | JAMES E CLARK
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Dates
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Enumeration Date | 06/23/2008
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Last Update Date | 06/23/2008
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Provider Practice Location Address
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Address Line | 105 S HILL ST
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City | GRIFFIN
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State | GA
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Zip | 30223-3401
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Country | US
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Telephone | 770-227-2346
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Fax | 770-227-2453
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Provider Business Mailing Address
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Address Line | PO BOX 188
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City | GRIFFIN
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State | GA
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Zip | 30224-0005
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Country | US
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Telephone | 770-227-2346
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Fax | 770-227-2453
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Authorized Official
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Title or Position | OWNER
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Name | JAMES EARL CLARK
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Credential | O.D.
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Telephone | 770-227-2346
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | 850
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License Number State | GA
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