Clark, Carolyn Sue

Clark, Carolyn Sue is an sole proprietor health care provider with primary practice located at 4925 Bradenton Ave Suite A, Dublin OH 43017-7532. She recently has only one registered license in Eye and Vision Services Providers / Vision Therapy, which is considered as her primary health care specialty. Clark, Carolyn Sue can be contacted via phone (614) 792-1974.

Contact Information

Primary practice address
4925 Bradenton Ave Suite A Dublin OH 43017-7532
Fax: (614) 760-1996
Website:

Health care specialties

SpecialtyCodeLicense #State
Eye and Vision Services Providers / Vision Therapy 152WV0400X 4089 Ohio

Profile Details

NPI number 1013079771
LBN Legal business name Clark, Carolyn Sue
Credentials Doctor of Optometry (OD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Dec 15th, 2006
Last updated May 18th, 2018 - about 8 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1013079771 NPPES
Ohio MEDICAID 0762509

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