Nickolas Wilson Clark, OD

Key facts

NPI

1740478403

Entity type

Individual (NPI type 1)

Primary specialty

Optometrist 152W00000X

License

0618002202 (VA)

Practice address

122 Tazewell St
Pearisburg, VA 24134

Phone

(540) 921-3921

Fax

(540) 921-1328

NPI assigned

Oct 9, 2007

Sex

Male

Sole proprietor

No

Organizations & group practices 3

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.

• Clarity Eye Care, PLC Optometrist · Pearisburg, VA · NPI 1326387754
  Medicare reassignment Care Compare group NPD Authorized official OPTOMETRIST · VA
• Clarity Eye Care, PLC Optometrist · Christiansburg, VA · NPI 1184103681
  Care Compare group NPD OPTOMETRIST
• Clark Family Vision PLC Optometrist · Davenport, IA · NPI 1548406002
  NPD (past) Authorized official OPTOMETRIST

Medicare Care Compare profile

Specialty

Optometry

Education

Southern College of Optometry, 2007

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Clarity Eye Care PLC (4 clinicians)

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare participation

Medicare fee-for-service enrollment

Enrolled in VA

Eligible to order & refer

Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes

Medicare enrollment records

National Provider Directory

Medicare enrollment (NPD)

Yes

Practice roles

Locations

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jul 6, 2018.

{
    "created_epoch": "1191888000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1530835200000",
    "number": "1740478403",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "122 TAZEWELL ST",
            "city": "PEARISBURG",
            "state": "VA",
            "postal_code": "241341632",
            "telephone_number": "540-921-3921",
            "fax_number": "540-921-1328"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "122 TAZEWELL ST",
            "city": "PEARISBURG",
            "state": "VA",
            "postal_code": "24134",
            "telephone_number": "540-921-3921",
            "fax_number": "540-921-1328"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1566 N Franklin St",
            "address_purpose": "LOCATION",
            "city": "Christiansburg",
            "state": "VA",
            "postal_code": "240731412",
            "country_code": "US",
            "telephone_number": "540-381-9086",
            "fax_number": "540-381-8183",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CLARK",
        "first_name": "NICKOLAS",
        "middle_name": "WILSON",
        "name_prefix": "Mr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-10-09",
        "last_updated": "2018-07-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "VA",
            "license": "0618002202",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pearisburg, VA

• Pippa Renee Chapman, D.C.
• Chiroworks Inc
• Clarity Eye Care, PLC
• Helen Jacqueline Clark, O.D.
• Joseph Lewis Clark
• Christopher Gary Cline, D.O.
• Commonwealth of Virginia State Board of Health
• Cook Nutrition
• Emily R Cook
• D. L. Bowling, O.D., P.C.

All providers in Pearisburg, VA · Optometrist in Virginia