G Gregory Clark, M.D.

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

License

0132124A Issued in IN

Practice address

9002 N Meridian St
Suite 112
Indianapolis, IN 46260-5381

Phone

(317) 843-9005

Fax

(317) 580-0443

NPI assigned

Nov 8, 2006

Last updated

Jan 5, 2008By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in IN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Visionary Eye Specialists LLC

  • Ophthalmology Physician
  • Indianapolis, IN
  • NPI 1316566797
  Medicare reassignment NPD

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

{
    "created_epoch": "1162944000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1199491200000",
    "number": "1679642912",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9002 N MERIDIAN ST",
            "address_2": "SUITE 112",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462605381",
            "telephone_number": "317-843-9005",
            "fax_number": "317-580-0443"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9002 N MERIDIAN ST",
            "address_2": "SUITE 112",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462605381",
            "telephone_number": "317-843-9005",
            "fax_number": "317-580-0443"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "G",
        "middle_name": "GREGORY",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-08",
        "last_updated": "2008-01-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "IN",
            "license": "0132124A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100326120",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS/BLUE SHIELD",
            "identifier": "000000538215",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Eleanor Ann Clark, LMHC-A
• Elizabeth Clark, MD
• Elizabeth Jane Clark, PHARMD
• Emily Elisabeth Clark, LCSW
• Emily Marie Clark, LCSW
• Georgia Ellen Clark, OD
• Gregory S Clark, PA-C
• Haleigh Clark
• Holly Marie Clark, D.D.S.
• Jackson Tyler Clark

• Ophthalmology Physician in Indianapolis, IN
• Providers in Indianapolis, IN by specialty
• Ophthalmology Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2008; 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.

Verify at the official NPI Registry.