Individual
DR. JOHN ALFRED CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
4000 CENTRAL FLORIDA BLVD, UNIVERSITY OF CENTRAL FL. - STUDENT UNION BLDG., ORLANDO, FL 32816-8005
(407) 823-4017
Mailing address
11225 BRONSON RD, CLERMONT, FL 34711-9318
(352) 409-5783
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
ODTA00379
RI
152W00000X
Optometrist
Primary
OP 1726
FL
Other
Enumeration date
08/31/2006
Last updated
07/08/2007
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