David Roger Clark, M.D.

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

License

E3162 Issued in TX

Practice address

2812 Millbrook CT
Arlington, TX 76012-2116

Phone

(817) 860-4393

NPI assigned

May 7, 2007

Last updated

Jul 11, 2007By 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 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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

{
    "created_epoch": "1178496000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1184112000000",
    "number": "1306059480",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2812 MILLBROOK CT",
            "city": "ARLINGTON",
            "state": "TX",
            "postal_code": "760122116"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2812 MILLBROOK CT",
            "city": "ARLINGTON",
            "state": "TX",
            "postal_code": "760122116",
            "telephone_number": "817-860-4393"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "DAVID",
        "middle_name": "ROGER",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-05-07",
        "last_updated": "2007-07-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "TX",
            "license": "E3162",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "P000AB990",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• CKC Holdings LLC (Cornerstone Pediatric Therapy)
• Melannie Leigh Clack, LCSW
• Rayne Eleanor Clapp
• Audrey Danay Clark
• Dana Gibbs Clark, MD
• John Darren Clark, MD
• Koryann Clark
• Latrece Clark
• Janeen Clark, PT, PT, DPT
• Rebecca A Clark, LPC

• Ophthalmology Physician in Arlington, TX
• Providers in Arlington, TX by specialty
• Ophthalmology Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2007; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.