Nicholas L Clark, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

3319 ATI Issued in OR

Practice address

2185 NW 2ND St
McMinnville, OR 97128-9108

Phone

(503) 435-1231

Fax

(503) 435-0151

NPI assigned

Nov 25, 2009

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Nicholas L Clark Professional name

Medicare fee-for-service enrollment

Enrolled in OR

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Optometry

Education

Pacific University - College of Optometry, 2009

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

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 and National Provider Directory roles.

• Nicholas L Clark, OD, LLC

  dba McMinnville Family Eye Care

  • Optometrist
  • McMinnville, OR
  • NPI 1548513583
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1259107200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1438128000000",
    "number": "1760710958",
    "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": {
        "last_name": "CLARK",
        "first_name": "NICHOLAS",
        "middle_name": "L",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-11-25",
        "last_updated": "2015-07-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "OR",
            "license": "3319 ATI",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "NICHOLAS",
            "last_name": "CLARK",
            "middle_name": "L",
            "credential": "OD, LLC",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Holly Churchill
• Kenneth M Cinnamon
• City of McMinnville (City of McMinnville Ambulance Service)
• Jessie Leigh Clark, APRNNP, FNPC, FNPBC
• Juliana Clark
• Susan Gaieen Clark, LCSW
• Lexie Clements
• David Ray Clevenger
• Windy Clevenger
• Alexis R Clure

• 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; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.