Active NPI
Ariene R Clark, O.D.
- Optometrist
- Lebanon, OR
National Provider Identifier
1467603225
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 3286ATI
- Practice address
- 90 Market St Ste 20
Lebanon, OR 97355-2396 - Phone
- (541) 451-1144
- Fax
- (541) 451-1785
- NPI assigned
- Oct 9, 2008
- Last updated
- Oct 28, 2021
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 3286ATI | OR | Primary |
| Optometrist | 152W00000X | 60091293 | WA |
Addresses
Primary practice location
90 Market St Ste 20
Lebanon, OR 97355-2396
Mailing address
90 Market St Ste 20
Lebanon, OR 97355-2396
Phone (541) 451-1144
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OR
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3286ATI | OR | MD | Optometrist |
| 60091293 | WA | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lifetime Vision Source of Lebanon LLC | Optometrist | Current | Accepting new patients |
| Eyecare Associates PC | Optometrist | Past | Accepting new patients |
| Luxottica of America Inc | Past | Accepting new patients |
Locations
90 Market St
Ste 20
Lebanon, OR 97355
Phone (541) 451-1144
Organizations & group practices 3
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.
-
- Optometrist
- Lebanon, OR
- NPI 1710168877
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1223510400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1635379200000",
"number": "1467603225",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "90 MARKET ST STE 20",
"city": "LEBANON",
"state": "OR",
"postal_code": "973552396",
"telephone_number": "541-451-1144",
"fax_number": "541-451-1785"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "90 MARKET ST STE 20",
"city": "LEBANON",
"state": "OR",
"postal_code": "973552396",
"telephone_number": "541-451-1144",
"fax_number": "541-451-1785"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "ARIENE",
"middle_name": "R",
"name_prefix": "Dr.",
"credential": "O.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-10-09",
"last_updated": "2021-10-28",
"certification_date": "2021-10-28",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "OR",
"license": "3286ATI",
"primary": true
},
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "WA",
"license": "60091293",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lebanon, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2021; 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.