Active NPI
Ann E Clark, O.D.
- Optometrist
- Wheaton, IL
National Provider Identifier
1073833034
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 046007084
- Practice address
- 2015 N Main St
Wheaton, IL 60187-3152 - Phone
- (630) 668-8250
- Fax
- (630) 668-9561
- NPI assigned
- Jun 1, 2010
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 046007084 | IL | Primary |
Addresses
Primary practice location
2015 N Main St
Wheaton, IL 60187-3152
Mailing address
2015 N Main St
Wheaton, IL 60187-3152
Phone (630) 668-8250
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1275350400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1275350400000",
"number": "1073833034",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2015 N MAIN ST",
"city": "WHEATON",
"state": "IL",
"postal_code": "601873152",
"telephone_number": "630-668-8250",
"fax_number": "630-668-9561"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2015 N MAIN ST",
"city": "WHEATON",
"state": "IL",
"postal_code": "601873152",
"telephone_number": "630-668-8250",
"fax_number": "630-668-9561"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "ANN",
"middle_name": "E",
"name_prefix": "Dr.",
"credential": "O.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-06-01",
"last_updated": "2010-06-01",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "IL",
"license": "046007084",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wheaton, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.