Active NPI
Gary L Clarke, O.D.
- Optometrist
- Gallipolis, OH
National Provider Identifier
1043272388
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 3220
- Practice address
- 308 Silver Bridge PLZ
Gallipolis, OH 45631-1833 - Phone
- (740) 446-2525
- Fax
- (740) 446-4371
- NPI assigned
- Apr 3, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 3220 | OH | Primary |
| Optometrist | 152W00000X | 641-D | WV |
Addresses
Primary practice location
308 Silver Bridge PLZ
Gallipolis, OH 45631-1833
Mailing address
308 Silver Bridge PLZ
Gallipolis, OH 45631-1833
Phone (740) 446-2525
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3110671970 | Other | OH | WORKERS' COMP OH |
| 9263881 | Other | OH | MEDICARE PTAN |
| 0150144000 | Medicaid | WV | |
| 1010821 | Other | WV | WORKERS' COMP WV |
| 0345700 | Medicaid | OH |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3220 | OH | MD | Optometrist |
| 641-D | WV | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1144022400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1341964800000",
"number": "1043272388",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "308 SILVER BRIDGE PLZ",
"city": "GALLIPOLIS",
"state": "OH",
"postal_code": "456311833",
"telephone_number": "740-446-2525",
"fax_number": "740-446-4371"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "308 SILVER BRIDGE PLZ",
"city": "GALLIPOLIS",
"state": "OH",
"postal_code": "456311833",
"telephone_number": "740-446-2525",
"fax_number": "740-446-4371"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARKE",
"first_name": "GARY",
"middle_name": "L",
"name_prefix": "Dr.",
"credential": "O.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-04-03",
"last_updated": "2012-07-11",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "OH",
"license": "3220",
"primary": true
},
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "WV",
"license": "641-D",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "WORKERS' COMP OH",
"identifier": "3110671970",
"state": "OH"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE PTAN",
"identifier": "9263881",
"state": "OH"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0150144000",
"state": "WV"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "WORKERS' COMP WV",
"identifier": "1010821",
"state": "WV"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0345700",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Gallipolis, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.