Brian M Clark, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

1742DT Issued in KY

Practice address

7635 Shelbyville Rd
Louisville, KY 40222-5409

Phone

(502) 423-8500

Fax

(502) 339-0571

NPI assigned

Jul 15, 2008

Last updated

Oct 20, 2010By 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

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in KY

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

Illinois College of Optometry at Chicago, 2008

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Gaddie Eye Centers LLCGroup PAC ID 6103898895, 8 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: brian.clark@direct.revolutionehr.com

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.

• Gaddie Eye Centers, LLC

  • Optometrist
  • Louisville, KY
  • NPI 1790759884
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1216080000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1287532800000",
    "number": "1164686572",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7635 SHELBYVILLE RD",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402225409",
            "telephone_number": "502-423-8500",
            "fax_number": "502-339-0571"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7635 SHELBYVILLE RD",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402225409",
            "telephone_number": "502-423-8500",
            "fax_number": "502-339-0571"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "BRIAN",
        "middle_name": "M",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-07-15",
        "last_updated": "2010-10-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "KY",
            "license": "1742DT",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P00850448",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100113750",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Anthony Rhoden Clark, D.M.D
• Austin Gregory Clark
• Austin Roy Clark
• Bailey Clark, DO
• Brenda S. Clark, MS, LPCC, NCC
• Charles Clark Jr., PT
• Christina Blume Clark, M.D., PH.D.
• Courtney Clark
• David Clark
• Donald Patrick Clark Jr., PHARMD

• Optometrist in Louisville, KY
• Providers in Louisville, KY by specialty
• Optometrist in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2010; 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.