Active NPI
Demetrice Clark, OD
- Optometrist
- Durham, NC
National Provider Identifier
1992750616
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 1385
- Practice address
- 2216 E NC Highway 54
Durham, NC 27713-2208 - Phone
- (919) 544-2020
- NPI assigned
- May 23, 2006
- Sex
- Female
- Sole proprietor
- No
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 | 1385 | NC | Primary |
Addresses
Primary practice location
2216 E NC Highway 54
Durham, NC 27713-2208
Mailing address
100 Glade Park Rd
Cary, NC 27518-8683
Phone (919) 363-2146
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1385 | NC | MD | Orthopedic Chiropractor |
Interoperability endpoints
- demetrice.clark@direct.revolutionehr.com
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1148342400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1430956800000",
"number": "1992750616",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "100 GLADE PARK RD",
"city": "CARY",
"state": "NC",
"postal_code": "275188683",
"telephone_number": "919-363-2146"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2216 E NC HIGHWAY 54",
"city": "DURHAM",
"state": "NC",
"postal_code": "277132208",
"telephone_number": "919-544-2020"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "DEMETRICE",
"credential": "OD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-05-23",
"last_updated": "2015-05-07",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "NC",
"license": "1385",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Durham, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2015; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.