Dr Michael Clark Optometrist PA

Primary specialty

OptometristTaxonomy code 152W00000X

License

0884 Issued in NC

Legal business name

DR MICHAEL CLARK OPTOMETRIST PA

Practice address

602 S Renfro St
Mount Airy, NC 27030-4742

Phone

(336) 789-9031

Fax

(336) 789-8343

NPI assigned

Oct 17, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Michael Clark, OD

Title

Optometrist

Phone

(336) 789-9031

Specialties & licenses 1

Addresses

Other identifiers 6

Other names 1

• Mt Airy Vision Center Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Thomas Anthony Bull, O.D.

  • Optometrist
  • Winston Salem, NC
  • NPI 1386623312
  NPD

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

{
    "created_epoch": "1161043200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1363824000000",
    "number": "1407936008",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "602 S RENFRO ST",
            "city": "MOUNT AIRY",
            "state": "NC",
            "postal_code": "270304742",
            "telephone_number": "336-789-9031",
            "fax_number": "336-789-8343"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "602 S RENFRO ST",
            "city": "MOUNT AIRY",
            "state": "NC",
            "postal_code": "270304742",
            "telephone_number": "336-789-9031",
            "fax_number": "336-789-8343"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR MICHAEL CLARK OPTOMETRIST PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-17",
        "last_updated": "2013-03-21",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "OPTOMETRIST",
        "authorized_official_telephone_number": "336-789-9031",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "NC",
            "license": "0884",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "89013MW",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE MEDICARE HMO",
            "identifier": "3739",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED MINE WORKERS",
            "identifier": "1409898",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VIRGINIA MEDICAID",
            "identifier": "9203311",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF NC",
            "identifier": "013MW",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PALMETTO GBA--RAILROAD MEDICARE",
            "identifier": "580000014",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mt Airy Vision Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jessica Doby
• Sydney Elizabeth Dockery, MSW, LCSWA
• Mark Alan Dodd, DO
• Jacqueline F Dorry, M.S. CCC-SLP
• Dr Larry Dean Simmons DDS PA
• Amanda Draughn, LPC
• Lauren Dry
• Jeffery Bryant Eads, LPC
• William Webster Eads, MDIV
• Lakin East, OTR/L

• All providers in Mount Airy, NC
• Optometrist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 21, 2013; 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.