Meredith Katherine Clark, O. D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

TA2371 Issued in MD

Practice address

920 Revolution St
Havre de Grace, MD 21078-3748

Phone

(410) 939-2200

Fax

(410) 939-5980

NPI assigned

Jun 28, 2012

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CT

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

Pennsylvania College of Optometry, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Envision 2020 Eyecare, LLCGroup PAC ID 8527493030, 4 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: drclark@directaddress.net

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.

• Envision 2020 Eyecare, LLC

  • Optometrist
  • Avon, CT
  • NPI 1801445028
  Medicare reassignment Care Compare group NPD
• Northern Connecticut Eye Associates, LLC

  • Ophthalmology Physician
  • Enfield, CT
  • NPI 1518294461

  Optometrist

  Medicare reassignment NPD
• Northern Connecticut Eye Associates, LLC

  • Eyewear Supplier
  • Enfield, CT
  • NPI 1487967832
  NPD

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

{
    "created_epoch": "1340841600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1411344000000",
    "number": "1124382601",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "920 REVOLUTION ST",
            "city": "HAVRE DE GRACE",
            "state": "MD",
            "postal_code": "210783748",
            "telephone_number": "410-939-2200",
            "fax_number": "410-939-5980"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "920 REVOLUTION ST",
            "city": "HAVRE DE GRACE",
            "state": "MD",
            "postal_code": "210783748",
            "telephone_number": "410-939-2200",
            "fax_number": "410-939-5980"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "MEREDITH",
        "middle_name": "KATHERINE",
        "credential": "O. D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-06-28",
        "last_updated": "2014-09-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "PA",
            "license": "OEG002639",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MD",
            "license": "TA2371",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EYEMED",
            "identifier": "A13586",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Citizens Nursing Home Board of Harford County
• Citizens Pharmacy Services Inc
• Citizens Pharmacy Services Inc
• Krysten Clark Wilkes, BCBA, LBA
• Kendra M Clark, RD,LDN
• Donovan Rochlitz Clifford, MSPT
• Melodie Cobb-Miller, BCBA LBA
• Nikia S. Coefield, PHARMD
• Hillary Coggins, LSW, BCBA, LBA
• Betsy Jane Cohen, FAAA

• Optometrist in Havre de Grace, MD
• Providers in Havre de Grace, MD by specialty
• Optometrist in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2014; 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.