Active NPI
Richard K Clark, OD
- Optometrist
- Ocala, FL
National Provider Identifier
1528059565
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 2341
- Practice address
- 810 NE 25TH Ave
Ocala, FL 34470-6335 - Phone
- (352) 732-0046
- Fax
- (352) 732-2649
- NPI assigned
- Oct 31, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 2341 | FL | Primary |
Addresses
Primary practice location
810 NE 25TH Ave
Ocala, FL 34470-6335
Mailing address
810 NE 25TH Ave
Ocala, FL 34470-6335
Phone (352) 732-0046
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 086895700 | Medicaid | FL | |
| 19818 | Other | FL | BLUE CROSS BLUE SHIELD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2341 | FL | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1130716800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1300406400000",
"number": "1528059565",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "810 NE 25TH AVE",
"city": "OCALA",
"state": "FL",
"postal_code": "344706335",
"telephone_number": "352-732-0046",
"fax_number": "352-732-2649"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "810 NE 25TH AVE",
"city": "OCALA",
"state": "FL",
"postal_code": "344706335",
"telephone_number": "352-732-0046",
"fax_number": "352-732-2649"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "RICHARD",
"middle_name": "K",
"name_prefix": "Dr.",
"credential": "OD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-10-31",
"last_updated": "2011-03-18",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "FL",
"license": "2341",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "086895700",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "19818",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Ocala, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.