Gregory Clark, O.D., Inc.

Primary specialty

OptometristTaxonomy code 152W00000X

License

2806 Issued in MN

Legal business name

GREGORY CLARK, O.D., INC.

Practice address

12547 Riverdale Blvd NW
Costco Optical Department
Coon Rapids, MN 55448-6708

Phone

(763) 712-7761

Fax

(763) 712-7787

NPI assigned

Nov 7, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Gregory Alexander Clark, O.D.NPI 1467521153

Title

Owner

Phone

(612) 703-0298

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

Locations

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Gregory Alexander Clark, O.D.

  • Optometrist
  • Coon Rapids, MN
  • NPI 1467521153
  Medicare reassignment Care Compare group NPD Authorized official
• Jason James Stensos, OD

  • Optometrist
  • Bloomington, MN
  • NPI 1205844966
  Medicare reassignment Care Compare group NPD
• Christina Nguyen Yang

  • Optometrist
  • Andover, MN
  • NPI 1407478969
  Medicare reassignment Care Compare group NPD
• Christina Ruby Tran, OD

  • Optometrist
  • Aurora, CO
  • NPI 1083222459

  MN

  Medicare reassignment

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

{
    "created_epoch": "1162857600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1354147200000",
    "number": "1801965504",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16160 22ND PL N",
            "city": "PLYMOUTH",
            "state": "MN",
            "postal_code": "554472382",
            "telephone_number": "612-703-0298"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12547 RIVERDALE BLVD NW",
            "address_2": "COSTCO OPTICAL DEPARTMENT",
            "city": "COON RAPIDS",
            "state": "MN",
            "postal_code": "554486708",
            "telephone_number": "763-712-7761",
            "fax_number": "763-712-7787"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREGORY CLARK, O.D., INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-07",
        "last_updated": "2012-11-29",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "GREGORY",
        "authorized_official_middle_name": "ALEXANDER",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "612-703-0298",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "MN",
            "license": "2806",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1634747-00",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lauren Ann Greely
• Green Lakes LLC
• Joseph Lynn Green, D.O.
• Zoe Green
• Jodi Greenlaw
• Laurie Ann Grengs, M.A.
• Koryn Greskowiak, AUD
• Brian J Greteman, DPM, PA
• Matthew J. Grigal, PT
• Jadie Gail Malark Grimm, MS, CCC-SLP

• Optometrist in Coon Rapids, MN
• Providers in Coon Rapids, MN by specialty
• Optometrist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 29, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.