Tina L Clark, LDO2206

Primary specialty

OpticianTaxonomy code 156FX1800X

License

LDO2206 Issued in GA

Practice address

557 Highway 11
Monroe, GA 30655-6078

Phone

(678) 758-4783

NPI assigned

Mar 12, 2024

Last updated

Mar 19, 2024By 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": "1710201600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710806400000",
    "number": "1902664022",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "557 HIGHWAY 11",
            "city": "MONROE",
            "state": "GA",
            "postal_code": "306556078",
            "telephone_number": "678-758-4783"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "557 HIGHWAY 11",
            "city": "MONROE",
            "state": "GA",
            "postal_code": "306556078",
            "telephone_number": "678-758-4783"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "TINA",
        "middle_name": "L",
        "credential": "LDO2206",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-03-12",
        "last_updated": "2024-03-19",
        "certification_date": "2024-03-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "156FX1800X",
            "taxonomy_group": "",
            "desc": "Technician/Technologist, Optician",
            "state": "GA",
            "license": "LDO2206",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shannon Christian, MD
• Chronic Disease Management of Georgia, LLC
• Circle of Care, Inc (Comfort Keepers)
• Pamela R. Clack, P.T.
• Thalaline Mayer Clack, PT, DPT
• Amy W Clegg, RPH
• Brenna Clinansmith, FNP-C
• Christina Cockerham, MHC
• Jeff Cohenour, MD
• Nicole Collazo Nieves

• Optician in Monroe, GA
• Providers in Monroe, GA by specialty
• Optician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2024; 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.