Andrew Clark, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

046007654 Issued in IL

Practice address

121 N Grand Ave W
Springfield, IL 62702-2562

Phone

(217) 528-3233

Fax

(217) 528-4511

NPI assigned

Jul 12, 2006

Last updated

Jun 12, 2012By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Springfield Clinic, LLP

  • Multi-Specialty Clinic/Center
  • Springfield, IL
  • NPI 1780638478
  NPD (past)

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

{
    "created_epoch": "1152662400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1339459200000",
    "number": "1164447272",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "121 N GRAND AVE W",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627022562",
            "telephone_number": "217-528-3233",
            "fax_number": "217-528-4511"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "121 N GRAND AVE W",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627022562",
            "telephone_number": "217-528-3233",
            "fax_number": "217-528-4511"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "ANDREW",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-12",
        "last_updated": "2012-06-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IL",
            "license": "046007654",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• City of Springfield Office of Budget & Management (Springfield Fire Department)
• Jenna Clancy
• McKenzie Kay Clanton
• Jude Anne Clapper, MS RD LDN CDE
• Abigail Clark
• Connie Lynn Clark, M.S.ED., LCPC
• Kelsey Jo Clark, CRNA
• Melissa Gayle Clark, PA-C
• Michelle Marie Clark, M.S., CCC-SLP
• Ted Robert Clark, M.D., M.P.P.

• Optometrist in Springfield, IL
• Providers in Springfield, IL by specialty
• Optometrist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 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.

Verify at the official NPI Registry.