Clark, Michael

Clark, Michael is an individual health care provider with primary practice located at 602 S Renfro St , Mount Airy NC 27030-4742. He recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as his primary health care specialty. Clark, Michael can be contacted via phone (336) 789-9031.

Contact Information

Primary practice address
602 S Renfro St Mount Airy NC 27030-4742
Phone: (336) 789-9031
Fax: (336) 789-8343
Website:
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Health care specialties

SpecialtyCodeLicense #State
Eye and Vision Services Providers / Optometrist 152W00000X 200001250552 North Carolina

Profile Details

NPI number 1851373252
LBN Legal business name Clark, Michael
Credentials Doctor of Optometry (OD)
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 19th, 2005
Last updated Jan 8th, 2014 - about 12 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 1851373252 NPPES
North Carolina Other 580000014 PALMETTO GBA--RAILROAD MEDICARE
North Carolina Other 1409898 PALMETTO GBA--RAILROAD MEDICARE
North Carolina Other 5612703280002 PALMETTO GBA--RAILROAD MEDICARE
North Carolina MEDICAID 8909154 PALMETTO GBA--RAILROAD MEDICARE
North Carolina Other 013MW PALMETTO GBA--RAILROAD MEDICARE
North Carolina Other 3739 PALMETTO GBA--RAILROAD MEDICARE

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