Linda Jean Clark, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

18002119 Issued in IN

Practice address

1765 Stafford Court
Goshen, IN 46526-6542

Phone

(574) 533-4910

Fax

(574) 534-3479

NPI assigned

Jan 22, 2007

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in IN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Optometry

Education

Indiana University - School of Optometry, 1984

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Michiana Eye Center LLC

  • Ophthalmology Physician
  • Goshen, IN
  • NPI 1659670685

  Optometrist

  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1169424000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1422835200000",
    "number": "1013061803",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1765 STAFFORD COURT",
            "city": "GOSHEN",
            "state": "IN",
            "postal_code": "465266542",
            "telephone_number": "574-533-4910",
            "fax_number": "574-534-3479"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1765 STAFFORD COURT",
            "city": "GOSHEN",
            "state": "IN",
            "postal_code": "465266542",
            "telephone_number": "574-533-4910",
            "fax_number": "574-534-3479"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "LINDA",
        "middle_name": "JEAN",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-01-22",
        "last_updated": "2015-02-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IN",
            "license": "18002119",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100112880A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Janelle E Christensen, MSW
• Linda Christophel
• City of Goshen
• Jill D Claassen
• Isidro Clara Jr.
• Barbara Jean Clem, MSN- FNP
• Johnathon Thomas Clifton
• Brodie Lee Cline
• Cynthia Lynn Coble
• Nathan Cole

• All providers in Goshen, IN
• Optometrist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 2, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.