Douglas Robert Clark, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

9844583-9934 Issued in UT

Practice address

446 N State Road 198
Salem, UT 84653

Phone

(801) 368-5987

NPI assigned

Apr 14, 2016

Last updated

May 22, 2019By 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

Medicare fee-for-service enrollment

Enrolled in UT

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 1

Specialty

Optometry

Education

Ferris State College - College of Optometry, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: dclark@directaddress.net

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.

• Salem Hills Family Eyecare LLC

  • Optometrist
  • Salem, UT
  • NPI 1831756055
  Medicare reassignment NPD Authorized official
• Erika Duggan

  • Optometrist
  • Henderson, NV
  • NPI 1194760454
  NPD (past)

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

{
    "created_epoch": "1460592000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1558483200000",
    "number": "1487008603",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "446 N STATE ROAD 198",
            "city": "SALEM",
            "state": "UT",
            "postal_code": "846534605"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "446 N STATE ROAD 198",
            "city": "SALEM",
            "state": "UT",
            "postal_code": "84653",
            "telephone_number": "801-368-5987"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "DOUGLAS",
        "middle_name": "ROBERT",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-04-14",
        "last_updated": "2019-05-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "UT",
            "license": "9844583-9934",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Canyon View Medical Group LLC (Salem Medical Clinic)
• Kashley Carter, DPT
• Central Utah Clinic, P.C. (Revere Health)
• Travis Brandon Charles, D.O.
• Kevin D. Christensen, M.D.
• Clear Life Counseling, LLC
• Brian A Clements, DO
• Maleah Eliza Creager
• Davis Sleep and TMJ
• Joel C Deehr, DMD

• Optometrist in Salem, UT
• Providers in Salem, UT by specialty
• Optometrist in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2019; 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.