Carolyn Sue Clark, O.D.

Primary specialty

Vision Therapy OptometristTaxonomy code 152WV0400X

License

4089 Issued in OH

Practice address

4925 Bradenton Ave
Suite a
Dublin, OH 43017-7532

Phone

(614) 792-1974

Fax

(614) 760-1996

NPI assigned

Dec 15, 2006

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 OH

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

Medicare enrollment (NPD)

Enrolled

Networks

• OH PPO
• devoted network organization-598bd2d4-c652-473f-ba7a-132f674c8eb6

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.

• Dublin Family Vision Center Inc

  • Optometrist
  • Dublin, OH
  • NPI 1982986204
  Medicare reassignment Authorized official

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

{
    "created_epoch": "1166140800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1526601600000",
    "number": "1013079771",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4925 BRADENTON AVE",
            "address_2": "SUITE A",
            "city": "DUBLIN",
            "state": "OH",
            "postal_code": "430177532",
            "telephone_number": "614-792-1974",
            "fax_number": "614-760-1996"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4925 BRADENTON AVE",
            "address_2": "SUITE A",
            "city": "DUBLIN",
            "state": "OH",
            "postal_code": "430177532",
            "telephone_number": "614-792-1974",
            "fax_number": "614-760-1996"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "CAROLYN",
        "middle_name": "SUE",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-12-15",
        "last_updated": "2018-05-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152WV0400X",
            "taxonomy_group": "",
            "desc": "Optometrist, Vision Therapy",
            "state": "OH",
            "license": "4089",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0762509",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jennifer A Clapper, RPH
• India Clardy
• Amanda Clark
• Angela Clark
• Anna Clark
• Erin Mechele Clark, MSW, LSW
• Jessi Clark
• Joanne Clark
• Karen Beth Clark, ACNP
• Michelle Clark

• Vision Therapy Optometrist in Dublin, OH
• Providers in Dublin, OH by specialty
• Vision Therapy Optometrist in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 2018; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.