Edward Owen Clark, LDO,ABOC

Primary specialty

OpticianTaxonomy code 156FX1800X

License

1101003836 Issued in VA

Practice address

12000 Iron Bridge Rd
Chester, VA 23831-1459

Phone

(804) 768-1273

NPI assigned

Dec 8, 2022

Last updated

Dec 8, 2022By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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": "1670457600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1670457600000",
    "number": "1952012130",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12000 IRON BRIDGE RD",
            "city": "CHESTER",
            "state": "VA",
            "postal_code": "238311459",
            "telephone_number": "804-768-1273"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12000 IRON BRIDGE RD",
            "city": "CHESTER",
            "state": "VA",
            "postal_code": "238311459",
            "telephone_number": "804-768-1273"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "EDWARD",
        "middle_name": "OWEN",
        "credential": "LDO,ABOC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-12-08",
        "last_updated": "2022-12-08",
        "certification_date": "2022-12-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "156FX1800X",
            "taxonomy_group": "",
            "desc": "Technician/Technologist, Optician",
            "state": "VA",
            "license": "1101003836",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Citagroup LLC (Cita Residential Services)
• Citagroup LLC
• John Silvius Ciurash, M.D.
• Clarity Hearing, LLC
• Clarity Wellness Counseling LLC
• Kara Anne Clark, ACNP
• Scott Clark Sr.
• Rochelle Clarke, LPC
• Clay Fleet Express LLC
• Melissa N. Clayton, A.N.P.

• Optician in Chester, VA
• Providers in Chester, VA by specialty
• Optician in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2022; 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.