Kathryn M Clark, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

831-OD Issued in WV

Practice address

2101 Jacob St. Suite 201
Valley Prof. Center South
Wheeling, WV 26003-6390

Phone

(304) 242-9245

Fax

(304) 242-6870

NPI assigned

Dec 5, 2006

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Raymond a Bannan

  • Ophthalmology Physician
  • Wheeling, WV
  • NPI 1841351400
  NPD (past)

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

{
    "created_epoch": "1165276800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1304467200000",
    "number": "1750449252",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "617 GLENHITE AVE",
            "city": "WHEELING",
            "state": "WV",
            "postal_code": "260036611",
            "telephone_number": "304-233-1482"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2101 JACOB ST. SUITE 201",
            "address_2": "VALLEY PROF. CENTER SOUTH",
            "city": "WHEELING",
            "state": "WV",
            "postal_code": "260036390",
            "telephone_number": "304-242-9245",
            "fax_number": "304-242-6870"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "KATHRYN",
        "middle_name": "M",
        "credential": "OD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-12-05",
        "last_updated": "2011-05-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WV",
            "license": "831-OD",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE WV GROUP PIN",
            "identifier": "DG8768",
            "state": "WV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE GROUP OH",
            "identifier": "DG5587",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0149721000",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Robert Basil Chrest Jr., D.O.
• Christian a. Sonnefeld, MD, PLLC
• Christopher Tiu MD, PLLC
• James Chuo, M.D.
• City of Wheeling
• Kimberly Clark
• Matalyn Clark, WHNP
• Terri L Clark, CRNA
• Susan Claycomb
• Paula Denise Clear

• Optometrist in Wheeling, WV
• Providers in Wheeling, WV by specialty
• Optometrist in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 4, 2011; 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.