Active NPI
Charles A Clark, OD
- Optometrist
- Corydon, IA
National Provider Identifier
1922090752
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 01637
- Practice address
- 212 N Franklin St
Corydon, IA 50060-1328 - Phone
- (641) 774-5819
- Fax
- (641) 774-8415
- NPI assigned
- Aug 18, 2005
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 01637 | IA | Primary |
Addresses
Primary practice location
212 N Franklin St
Corydon, IA 50060-1328
Mailing address
212 N Franklin St
PO Box 611
Corydon, IA 50060-1328
Phone (641) 774-5819
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3162669 | Medicaid | IA | |
| 410045287 | Other | IA | RAILROAD MEDICARE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Des Moines Eye Surgeons, LLP | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Ophthalmology Physician
- W Des Moines, IA
- NPI 1417956103
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1124323200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1468281600000",
"number": "1922090752",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "212 N FRANKLIN ST",
"address_2": "PO BOX 611",
"city": "CORYDON",
"state": "IA",
"postal_code": "500601328",
"telephone_number": "641-774-5819",
"fax_number": "641-774-8415"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "212 N FRANKLIN ST",
"city": "CORYDON",
"state": "IA",
"postal_code": "500601328",
"telephone_number": "641-774-5819",
"fax_number": "641-774-8415"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "CHARLES",
"middle_name": "A",
"credential": "OD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-08-18",
"last_updated": "2016-07-12",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "IA",
"license": "01637",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3162669",
"state": "IA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "410045287",
"state": "IA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Corydon, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.