Clark Family Vision PLC

Primary specialty

OptometristTaxonomy code 152W00000X

License

002399 Issued in IA

Legal business name

CLARK FAMILY VISION PLC

Practice address

5811 Elmore Ave
Davenport, IA 52807-3513

Phone

(563) 359-5008

NPI assigned

Jan 5, 2009

Last updated

Oct 5, 2010By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Nickolas Wilson Clark, ODNPI 1740478403

Title

Manager

Phone

(319) 533-2399

Specialties & licenses 1

Addresses

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Nickolas Wilson Clark, OD

  • Optometrist
  • Pearisburg, VA
  • NPI 1740478403
  NPD (past) Authorized official
• Helen Jacqueline Clark, O.D.

  • Optometrist
  • Pearisburg, VA
  • NPI 1972788610
  NPD (past)

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

{
    "created_epoch": "1231113600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1286236800000",
    "number": "1548406002",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2211 PARKWAY DR",
            "city": "BETTENDORF",
            "state": "IA",
            "postal_code": "527223007",
            "telephone_number": "319-533-2399"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5811 ELMORE AVE",
            "city": "DAVENPORT",
            "state": "IA",
            "postal_code": "528073513",
            "telephone_number": "563-359-5008"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLARK FAMILY VISION PLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-01-05",
        "last_updated": "2010-10-05",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "NICKOLAS",
        "authorized_official_middle_name": "WILSON",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "319-533-2399",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IA",
            "license": "002399",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Matthew C Christophersen, MD
• Carol Ann Chukwuka, ARNP
• Kassidee Church
• Ciaccio Medical, P.C.
• Mackenzie J Cichon
• Chamein K Clark Witter, DCPC
• Cathleen Ann Clark, LICSW
• Katherine Louise Clark, D.C.
• Madison Linn Clark, LSW
• Monica Mary Clark, MSW LISW LMFT

• Optometrist in Davenport, IA
• Providers in Davenport, IA by specialty
• Optometrist in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2010; 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.