Active NPI
Thomas David Clark, O.D.
- Optometrist
- Evansville, IN
National Provider Identifier
1720133671
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 18002530 B
- Practice address
- 1401 N Green River Rd
Evansville, IN 47715-2428 - Phone
- (812) 479-5025
- Fax
- (812) 479-5060
- NPI assigned
- Jan 23, 2007
- Sex
- Male
- Sole proprietor
- Yes
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 | 18002530 B | IN | Primary |
Addresses
Primary practice location
1401 N Green River Rd
Evansville, IN 47715-2428
Mailing address
820 Cobblestone Dr
Evansville, IN 47715-4287
Phone (812) 401-3508
Medicare participation
Medicare enrollment files- 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: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20110628000745 | IN | Order and Referring Only - Optometry | 0143408831 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 18002530 B | IN | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Clark Visioncare, LLC | Optometrist | Past | Accepting new patients |
| National Vision, Inc. | Optometrist | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Optometrist
- Evansville, IN
- NPI 1801052618
-
- Optometrist
- Evansville, IN
- NPI 1750437976
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1169510400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1308614400000",
"number": "1720133671",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "820 COBBLESTONE DR",
"city": "EVANSVILLE",
"state": "IN",
"postal_code": "477154287",
"telephone_number": "812-401-3508"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1401 N GREEN RIVER RD",
"city": "EVANSVILLE",
"state": "IN",
"postal_code": "477152428",
"telephone_number": "812-479-5025",
"fax_number": "812-479-5060"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "THOMAS",
"middle_name": "DAVID",
"name_prefix": "Dr.",
"credential": "O.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-01-23",
"last_updated": "2011-06-21",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "IN",
"license": "18002530 B",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Evansville, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2011; 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.