Robert T Clark MD PC

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

License

4301040778 Issued in MI

Legal business name

ROBERT T CLARK MD PC

Practice address

7575 Grand River Rd
Suite 111
Brighton, MI 48114-9309

Phone

(810) 844-7744

Fax

(810) 844-7725

NPI assigned

Dec 28, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Robert Thomas Clark, MD

Title

President

Phone

(810) 844-7744

Specialties & licenses 2

Addresses

Other identifiers 3

Other names 2

• Clark Eye Center Doing business as
• Clark Tait Eye Center Doing business as

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in MI2 enrollments

Enrollment records 2

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Interoperability endpoints

• Direct secure messaging: drclark@clarkeye.direct.eyemdemr.com

Practitioners 8

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

• Clay James Connolly, OD

  • Optometrist
  • Brighton, MI
  • NPI 1033649231
  Medicare reassignment Care Compare group NPD
• Elizabeth Duvall, MD

  • Ophthalmology Physician
  • Royal Oak, MI
  • NPI 1497249957
  Medicare reassignment Care Compare group NPD
• Stephen M Tait, MD PHD

  • Ophthalmology Physician
  • Brighton, MI
  • NPI 1376534164
  Medicare reassignment Care Compare group NPD
• Steven P Lutz, O.D.

  • Optometrist
  • Ann Arbor, MI
  • NPI 1831159268
  Medicare reassignment NPD
• John R. Suchomel, M.D.

  • Ophthalmology Physician
  • Detroit, MI
  • NPI 1801955851
  NPD (past)
• Steven S Zeldes, MD

  • Ophthalmology Physician
  • West Bloomfield, MI
  • NPI 1093708844
  NPD (past)
• Jill Marie Haven, O.D.

  • Optometrist
  • Austin, TX
  • NPI 1265433924
  NPD (past)
• James Rogala, OD

  • Optometrist
  • Pikeville, KY
  • NPI 1053454835
  NPD (past)

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

{
    "created_epoch": "1167264000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1623715200000",
    "number": "1821154667",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7575 WEST GRAND RIVER",
            "address_2": "SUITE 111",
            "city": "BRIGHTON",
            "state": "MI",
            "postal_code": "481149390",
            "telephone_number": "810-844-7744",
            "fax_number": "810-844-7725"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7575 GRAND RIVER RD",
            "address_2": "SUITE 111",
            "city": "BRIGHTON",
            "state": "MI",
            "postal_code": "481149309",
            "telephone_number": "810-844-7744",
            "fax_number": "810-844-7725"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROBERT T CLARK MD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-28",
        "last_updated": "2021-06-15",
        "certification_date": "2021-06-15",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "THOMAS",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "810-844-7744",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Ophthalmology",
            "state": "MI",
            "license": "4301040778",
            "primary": true
        },
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": "MI",
            "license": "4301040778",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DME SUPPLIER",
            "identifier": "0297200001",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "102681557",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GRP # BCBS",
            "identifier": "0D710210",
            "state": "MI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "DrClark@clarkeye.direct.eyemdemr.com",
            "affiliation": "N",
            "endpointDescription": "Dr Clark Direct email address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Medical office",
            "address_1": "7575 Grand River Rd",
            "address_2": "Suite 111",
            "city": "Brighton",
            "state": "MI",
            "country_code": "US",
            "postal_code": "481149309",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Clark Eye Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Clark Tait Eye Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Brooke Lynee Risner
• Kimberly Rizzo, NP
• Jacqueline Dellwo Robbins, M.A.L.L.P.
• Natashia Robbins, PH.D.
• Kathleen Marie Roberson, LPC
• Roberta Hitt PHD PLC
• Roberta Hitt PHD PLC
• Carolyn Ann Roberts
• Havoc Kane Roberts
• Nicole M Robertson, MT

• Ophthalmology Physician in Brighton, MI
• Providers in Brighton, MI by specialty
• Ophthalmology Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.