Individual
LINDA JEAN CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
1765 STAFFORD COURT, GOSHEN, IN 46526-6542
(574) 533-4910
(574) 534-3479
Mailing address
1765 STAFFORD COURT, GOSHEN, IN 46526-6542
(574) 533-4910
(574) 534-3479
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
18002119
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100112880A
—
IN
Enumeration date
01/22/2007
Last updated
02/02/2015
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