Christopher Inman Clark, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

OD00003035TX Issued in WA

Practice address

100 4TH Ave N
Suite 145
Seattle, WA 98109-4905

Phone

(206) 728-7505

NPI assigned

Jun 30, 2006

Last updated

May 21, 2008By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 4

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in WA

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

State University of New York - State College Optometry, 1990

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Pearl Eye Care Center PSGroup PAC ID 4587634829, 2 clinicians

Olympia Vision Clinic and Contact Lens Center, PLLCGroup PAC ID 8820080237, 10 clinicians

Eric Bergstrom OD, PLLCGroup PAC ID 0941190417, 11 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Eric Bergstrom OD, PLLC

  dba Eye Clinics of Seattle - Roosevelt

  • Optometrist
  • Seattle, WA
  • NPI 1124289897
  Medicare reassignment Care Compare group NPD
• Olympia Vision Clinic and Contact Lens Center, PLLC

  • Optometrist
  • Olympia, WA
  • NPI 1962544692
  Medicare reassignment Care Compare group NPD
• Pearl Eye Care Center, P.S.

  • Optometrist
  • University Place, WA
  • NPI 1376730382
  Medicare reassignment Care Compare group NPD
• Bridgeport Family Vision Clinic, PLLC

  • Optometrist
  • Lakewood, WA
  • NPI 1235517541
  Medicare reassignment NPD
• Spex in the City, LLC

  • Eyewear Supplier
  • Seattle, WA
  • NPI 1548769037
  Medicare reassignment NPD
• Pearl Eye Care Center, P.S.

  dba Noble Eyes & Vision Center

  • Optometrist
  • Tukwila, WA
  • NPI 1215675442
  NPD
• Pearl Eyecare Center P S

  dba Puyallup Vision Source

  • Optometrist
  • Puyallup, WA
  • NPI 1174294870
  NPD
• David Thomas Williams

  dba Bridgeport Vision Clinic

  • Optometrist
  • Lakewood, WA
  • NPI 1508043019
  NPD (past)
• New Eyedentity, LLC

  • Optometrist
  • Seattle, WA
  • NPI 1255521431
  NPD (past)

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

{
    "created_epoch": "1151625600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1211328000000",
    "number": "1265461594",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 4TH AVE N",
            "address_2": "SUITE 145",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981094905",
            "telephone_number": "206-728-7505"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 4TH AVE N",
            "address_2": "SUITE 145",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981094905",
            "telephone_number": "206-728-7505"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "CHRISTOPHER",
        "middle_name": "INMAN",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-06-30",
        "last_updated": "2008-05-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WA",
            "license": "OD00003035TX",
            "primary": true
        },
        {
            "code": "152WP0200X",
            "taxonomy_group": "",
            "desc": "Optometrist, Pediatrics",
            "state": "WA",
            "license": "OD00003035TX",
            "primary": false
        },
        {
            "code": "152WS0006X",
            "taxonomy_group": "",
            "desc": "Optometrist, Sports Vision",
            "state": "WA",
            "license": "OD00003035TX",
            "primary": false
        },
        {
            "code": "152WV0400X",
            "taxonomy_group": "",
            "desc": "Optometrist, Vision Therapy",
            "state": "WA",
            "license": "OD00003035TX",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE WA HEALTH",
            "identifier": "CL4555",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WA DEPT OF LABOR & INDUST",
            "identifier": "143253",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Caroline Ashton Clark, PA-C
• Cassandra Clark, PH.D.
• Celeste Marie Clark, MA61290074
• Chelsea D. Clark, RC
• Christine Clark, LSWAIC
• Clancy J Clark, MD
• David Clark
• Deborah Faye Clark
• Eric Christopher Clark, CRNA
• Herbert R. Clark, M.D.

• Optometrist in Seattle, WA
• Providers in Seattle, WA by specialty
• Optometrist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2008; 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.