Shane Alexander Clark, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

725 Issued in SD

Practice address

5734 Sheridan Lake Rd
Suite 202
Rapid City, SD 57702-8811

Phone

(605) 342-0258

Fax

(605) 342-0209

NPI assigned

Jun 29, 2011

Last updated

Aug 10, 2023By 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 TN, SD2 enrollments

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 2

Specialty

Optometry

Education

Southern College of Optometry, 2011

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Black Hills Regional Eye Institute LLPGroup PAC ID 0547156762, 13 clinicians

Practice addresses (Care Compare)

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.

• Black Hills Regional Eye Institute, LLP

  • Ophthalmology Physician
  • Rapid City, SD
  • NPI 1952381881

  Optometrist

  Medicare reassignment Care Compare group NPD
• Infinity Eyecare, PC

  • Optometrist
  • Rapid City, SD
  • NPI 1306202700
  Medicare reassignment Authorized official
• Dr. Mark Lynn & Associates, PLLC

  dba Visionworks Doctors of Optometry

  • Optometrist
  • Franklin, TN
  • NPI 1194739490
  Medicare reassignment NPD
• Vision Therapy Center LLC

  • Vision Therapy Optometrist
  • Rapid City, SD
  • NPI 1356991624
  NPD Authorized official
• Black Hills Regional Eye Institute, LLP

  • Ophthalmology Physician
  • Chadron, NE
  • NPI 1043778103

  Optometrist

  NPD
• Eyecare Associates of Southwest Iowa Inc

  • Optometrist
  • Clarinda, IA
  • NPI 1801887484
  NPD (past)

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

{
    "created_epoch": "1309305600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1691625600000",
    "number": "1437446440",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3027 ROXBURY CIR",
            "city": "RAPID CITY",
            "state": "SD",
            "postal_code": "577025301",
            "telephone_number": "816-853-9407",
            "fax_number": "605-342-0209"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5734 SHERIDAN LAKE RD",
            "address_2": "SUITE 202",
            "city": "RAPID CITY",
            "state": "SD",
            "postal_code": "577028811",
            "telephone_number": "605-342-0258",
            "fax_number": "605-342-0209"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "SHANE",
        "middle_name": "ALEXANDER",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-06-29",
        "last_updated": "2023-08-10",
        "certification_date": "2023-08-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "SD",
            "license": "725",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• City of Rapid City (City of Rapid City - Rapid City Fire Dept)
• City of Rapid City (Rapid City Fire and Emergency Service)
• Jamie J Clapham, PT
• Dorothy Clark
• Kelly J Clark
• Megan Claymore
• Rebecca Michelle Claymore, MS LPC QMHP
• Clear Connections Counseling LLC
• Clear Horizons LLC
• Brianna Lynn Clemetson, DMD

• Optometrist in Rapid City, SD
• Providers in Rapid City, SD by specialty
• Optometrist in South Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2023; 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.