Nicholas L Clark, OD, LLC

Primary specialty

OptometristTaxonomy code 152W00000X

License

3319ATI Issued in OR

Legal business name

NICHOLAS L CLARK, OD, LLC

Doing business as

McMinnville Family Eye Care

Practice address

2185 NW 2ND St
McMinnville, OR 97128-9108

Phone

(503) 435-1231

Fax

(503) 435-0151

NPI assigned

Oct 15, 2012

Last updated

Jul 29, 2015By 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

Nicholas L Clark, O.D.NPI 1760710958

Title

Optometrist

Phone

(503) 435-1231

Specialties & licenses 1

Addresses

Other names 1

• McMinnville Family Eye Care Doing business as

Medicare fee-for-service enrollment

Enrolled in OR

Enrollment records 1

Locations

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.

• Nicholas L Clark, O.D.

  • Optometrist
  • McMinnville, OR
  • NPI 1760710958
  Medicare reassignment NPD Authorized official
• Mina Fordyce, O.D.

  • Optometrist
  • Bellevue, WA
  • NPI 1922333012

  OR

  Medicare reassignment NPD

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

{
    "created_epoch": "1350259200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1438128000000",
    "number": "1548513583",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2185 NW 2ND ST",
            "city": "MCMINNVILLE",
            "state": "OR",
            "postal_code": "971289108",
            "telephone_number": "503-435-1231",
            "fax_number": "503-435-0151"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2185 NW 2ND ST",
            "city": "MCMINNVILLE",
            "state": "OR",
            "postal_code": "971289108",
            "telephone_number": "503-435-1231",
            "fax_number": "503-435-0151"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NICHOLAS L CLARK, OD, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-10-15",
        "last_updated": "2015-07-29",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "NICHOLAS",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OPTOMETRIST",
        "authorized_official_telephone_number": "503-435-1231",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "OR",
            "license": "3319ATI",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "McMinnville Family Eye Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Gabriella A Newell
• Kimya-Anhcina Lan Nguyen, DO
• Lizette Nguyen, RDH
• Patricia Hoangphuong Nguyen
• Michael Niad, D.D.S
• Courtney Nichols
• Christopher James Nickell
• Nisha Jackson PC
• Cynthia Louise Nisly, MA
• Jeanette Nisly, R.N., MSN

• Optometrist in McMinnville, OR
• Providers in McMinnville, OR by specialty
• Optometrist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.