Clark, Dwight Eugene
Clark, Dwight Eugene is an sole proprietor health care provider with primary practice located at 11216 Trinity River Drive , Rancho Cordova CA 95670. He recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as his primary health care specialty. Clark, Dwight Eugene can be contacted via phone (916) 635-6161.Contact Information
Primary practice address
11216 Trinity River Drive
Rancho Cordova CA 95670
Phone: (916) 635-6161
Fax: (916) 631-3788
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Eye and Vision Services Providers / Optometrist | 152W00000X | 5512 | California |
Profile Details
| NPI number | 1043321169 |
|---|---|
| LBN Legal business name | Clark, Dwight Eugene |
| Credentials | Doctor of Optometry (OD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Aug 31st, 2006 |
| Last updated | Nov 28th, 2011 - about 15 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 | 1043321169 | NPPES |
| California | MEDICAID | SD0055120 |
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