Brel Clark,O.D.,P.C.

Primary specialty

OptometristTaxonomy code 152W00000X

License

OPT000940 Issued in GA

Legal business name

BREL CLARK,O.D.,P.C.

Practice address

5279 Whittlesey Blvd Ste 100
Columbus, GA 31909-3073

Phone

(706) 405-7308

Fax

(706) 324-4939

NPI assigned

Aug 15, 2016

Organization subpart

No

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

Authorized official

Name

Dr. Brel Clark, O.D.NPI 1619075033

Title

Owner/Optometrist

Phone

(706) 405-7308

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Brel Clark, OD, PC

  • Optometrist
  • Columbus, GA
  • NPI 1619075033
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1471219200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1471219200000",
    "number": "1962956359",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4259",
            "city": "COLUMBUS",
            "state": "GA",
            "postal_code": "319140259",
            "telephone_number": "706-405-7308",
            "fax_number": "706-324-4939"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5279 WHITTLESEY BLVD STE 100",
            "city": "COLUMBUS",
            "state": "GA",
            "postal_code": "319093073",
            "telephone_number": "706-405-7308",
            "fax_number": "706-324-4939"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BREL CLARK,O.D.,P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-08-15",
        "last_updated": "2016-08-15",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "BREL",
        "authorized_official_title_or_position": "OWNER/OPTOMETRIST",
        "authorized_official_telephone_number": "706-405-7308",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "GA",
            "license": "OPT000940",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000229215G",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Optometrist in Columbus, GA
• Providers in Columbus, GA by specialty
• Optometrist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.