Patrick James Clark Jr., O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

10580T Issued in CA

Practice address

101 Bodin Cir
60 MDG/Amds Optometry Clinic
Travis AFB, CA 94535-1809

Phone

(707) 423-7171

NPI assigned

Apr 19, 2006

Last updated

Feb 13, 2014By 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

Enrolled in CA

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

University of California - School of Optometry, 1995

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Regents of the University of California at BerkeleyGroup PAC ID 8628083110, 57 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: pclark348915@direct-ucsfmedicalcenter.org
• Direct secure messaging: pclark584885@direct.ochin.org

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.

• Regents of the University of California at Berkeley

  • Optometrist
  • Berkeley, CA
  • NPI 1306908058
  Medicare reassignment Care Compare group NPD
• Petaluma Health Center Inc

  dba Petaluma Health Center

  • Federally Qualified Health Center (FQHC)
  • Petaluma, CA
  • NPI 1588656268
  Medicare reassignment NPD
• The West Oakland Health Council

  dba Baywell Health

  • Federally Qualified Health Center (FQHC)
  • Oakland, CA
  • NPI 1285754234
  Medicare reassignment NPD
• Petaluma Health Center Inc

  dba Rohnert Park Health Center

  • Federally Qualified Health Center (FQHC)
  • Rohnert Park, CA
  • NPI 1669870739
  NPD
• Petaluma Health Center, Inc

  dba Casa Grande High School Health Clinic

  • Federally Qualified Health Center (FQHC)
  • Petaluma, CA
  • NPI 1437918406
  NPD
• The West Oakland Health Council

  dba Baywell Health

  • Psychiatric/Mental Health Nurse Practitioner
  • Oakland, CA
  • NPI 1043331630
  NPD
• The West Oakland Health Council

  dba Baywell Health

  • Federally Qualified Health Center (FQHC)
  • Berkeley, CA
  • NPI 1184744138
  NPD

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

{
    "created_epoch": "1145404800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1392249600000",
    "number": "1285699553",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 BODIN CIR",
            "address_2": "60 MDG/AMDS OPTOMETRY CLINIC",
            "city": "TRAVIS AFB",
            "state": "CA",
            "postal_code": "945351809",
            "telephone_number": "707-423-7171"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 BODIN CIR",
            "address_2": "60 MDG/AMDS OPTOMETRY CLINIC",
            "city": "TRAVIS AFB",
            "state": "CA",
            "postal_code": "945351809",
            "telephone_number": "707-423-7171"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "PATRICK",
        "middle_name": "JAMES",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-19",
        "last_updated": "2014-02-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "10580T",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Leslie A Christopher, WHNP
• Jack Koji Chung, DDS
• Michael Louis Chyrek, O.D.
• Beth Clark
• Heidi Lynn Clark, RD
• Richard Andrew Clark, M.D
• Kimberley W Coleman
• Katelynn Marie Collins, MD
• Erika Conklin, CADC
• Ryan Lee Cook

• Optometrist in Travis AFB, CA
• Providers in Travis AFB, CA by specialty
• Optometrist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 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.