Clark, Jacob A

Clark, Jacob A is an sole proprietor health care provider with primary practice located at 411 N Washington St , Alexandria VA 22314-2311. He recently has only one registered license in Allopathic & Osteopathic Physicians / Ophthalmology, which is considered as his primary health care specialty. Clark, Jacob A can be contacted via phone (703) 548-5588.

Contact Information

Primary practice address
411 N Washington St Alexandria VA 22314-2311
Phone: (703) 548-5588
Fax: (703) 549-1599
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Ophthalmology 207W00000X 0101041044 Virginia

Profile Details

NPI number 1164464806
LBN Legal business name Clark, Jacob A
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jun 10th, 2006
Last updated Jan 21st, 2010 - about 16 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 1164464806 NPPES
Virginia MEDICAID 6375570

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