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General NPI Number Information
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NPI Number | 1992751614
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Entity Type | Individual
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Provider Name | CLARK MITCHELL OCKER O.D.
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Gender | Male
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Dates
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Enumeration Date | 05/25/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1665 STATE HILL RD
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City | WYOMISSING
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State | PA
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Zip | 19610-1900
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Country | US
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Telephone | 610-376-1589
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Fax | 610-374-2808
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Provider Business Mailing Address
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Address Line | 4 WYOMISSING BLVD
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City | WYOMISSING
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State | PA
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Zip | 19610-2055
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Country | US
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Telephone | 610-376-6108
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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 | OEG001638
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License Number State | PA
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