Blackwood, Clark
Blackwood, Clark is an individual health care provider with primary practice located at 2080 N Main St , Longmont CO 80501-1916. He recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as his primary health care specialty. Blackwood, Clark can be contacted via phone (303) 651-2020.Contact Information
Primary practice address
2080 N Main St
Longmont CO 80501-1916
Phone: (303) 651-2020
Fax: (303) 776-2460
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Eye and Vision Services Providers / Optometrist | 152W00000X | 847 | Colorado |
Profile Details
| NPI number | 1518075324 |
|---|---|
| LBN Legal business name | Blackwood, Clark |
| Credentials | Doctor of Optometry (OD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Aug 29th, 2006 |
| Last updated | May 23rd, 2012 - about 14 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1518075324 | NPPES |
| Colorado | MEDICAID | 08008476 |
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