Georgianne M Clark

Primary specialty

OpticianTaxonomy code 156FX1800X

License

OPTI.DO.61617192 Issued in WA

Practice address

306 5TH St
Clarkston, WA 99403-1860

Phone

(509) 758-9470

Fax

(509) 758-9478

NPI assigned

Oct 22, 2025

Last updated

Oct 22, 2025By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1761091200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1761091200000",
    "number": "1831066984",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1239 VINEYARD AVE",
            "city": "LEWISTON",
            "state": "ID",
            "postal_code": "835014271",
            "telephone_number": "509-758-9470",
            "fax_number": "509-758-9478"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "306 5TH ST",
            "city": "CLARKSTON",
            "state": "WA",
            "postal_code": "994031860",
            "telephone_number": "509-758-9470",
            "fax_number": "509-758-9478"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "GEORGIANNE",
        "middle_name": "M",
        "name_prefix": "Mrs.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-10-22",
        "last_updated": "2025-10-22",
        "certification_date": "2025-10-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "156FX1800X",
            "taxonomy_group": "",
            "desc": "Technician/Technologist, Optician",
            "state": "WA",
            "license": "OPTI.DO.61617192",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Donald Kenneth Chin, MD
• Daniel Christianson
• Brian Francis Ciezki, ACNP
• City of Clarkston (Clarkston Fire Department)
• Clarity of Mind Counseling LLC
• Clarkston Denturist Clinic
• Clarkston Heights Pharmacy
• Clarkston of Cascadia, LLC
• Clarkston School District
• Clearwater Anesthesia PC

• Optician in Clarkston, WA
• Providers in Clarkston, WA by specialty
• Optician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2025; 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.