Stephen Brent Clark, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

OPT002352 Issued in GA

Practice address

8390 North Hwy 27
Rock Spring, GA 30739-2103

Phone

(706) 375-1720

Fax

(706) 375-1729

NPI assigned

Jul 21, 2005

Last updated

Jul 22, 2010By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 5

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Optometry

Education

Other, 2003

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

North Georgia Vision Center IncGroup PAC ID 8628148327, 3 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• North Georgia Vision Center Inc

  • Optometrist
  • Rock Spring, GA
  • NPI 1952569279
  Medicare reassignment Care Compare group NPD Authorized official
• North Georgia Vision Center Inc

  • Optician
  • Rock Spring, GA
  • NPI 1285732115
  NPD (past)
• Chattanooga Vision Center, PLC

  • Ophthalmology Physician
  • Chattanooga, TN
  • NPI 1982679296

  Optometrist

  NPD (past)
• North Park Eye Center P C

  • Ophthalmology Physician
  • Hixson, TN
  • NPI 1073503298

  Optometrist

  NPD (past)

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

{
    "created_epoch": "1121904000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1279756800000",
    "number": "1952300832",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8390 NORTH HWY 27",
            "city": "ROCK SPRING",
            "state": "GA",
            "postal_code": "307392103",
            "telephone_number": "706-375-1720",
            "fax_number": "706-375-1729"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8390 NORTH HWY 27",
            "city": "ROCK SPRING",
            "state": "GA",
            "postal_code": "307392103",
            "telephone_number": "706-375-1720",
            "fax_number": "706-375-1729"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "STEPHEN",
        "middle_name": "BRENT",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-21",
        "last_updated": "2010-07-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "GA",
            "license": "OPT002352",
            "primary": true
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "TN",
            "license": "OD002478",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UHC",
            "identifier": "26-2355581",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "194699738A",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "1952300832",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "511G700557",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP NPI",
            "identifier": "1952569279",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Alc Hospice Care, LLC.
• Andrew Besh, DPT
• Calvary Healthcare, Inc
• David Stephen Cofer, NP-C
• Tara Michele Dennison, MSN-ED, BSN, RN
• Stacey Michelle Foley
• Stacey Gilbreath
• Jennifer Nicole Hennon

• Optometrist in Rock Spring, GA
• Providers in Rock Spring, GA by specialty
• Optometrist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.