Dr Scott B Clark Optometrist

Primary specialty

OptometristTaxonomy code 152W00000X

Legal business name

DR SCOTT B CLARK OPTOMETRIST

Practice address

491 Rantoul St
Beverly, MA 01915-3231

Phone

(978) 922-4732

NPI assigned

Nov 29, 2006

Organization subpart

No

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

Authorized official

Name

Scott B Clark, OD

Title

Owner

Phone

(508) 922-4732

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1164758400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1285701748",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "491 RANTOUL ST",
            "city": "BEVERLY",
            "state": "MA",
            "postal_code": "019153231"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "491 RANTOUL ST",
            "city": "BEVERLY",
            "state": "MA",
            "postal_code": "019153231",
            "telephone_number": "978-922-4732"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR SCOTT B CLARK OPTOMETRIST",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-29",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "SCOTT",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "508-922-4732",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "W20333",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Optometrist in Beverly, MA
• Providers in Beverly, MA by specialty
• Optometrist in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.