Individual
SAMANTHA CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
2878 MILLER DR, PLYMOUTH, IN 46563-8094
(574) 935-3937
(574) 936-4942
Mailing address
111 E 4TH ST STE 440, ALTON, IL 62002-6206
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
18004186A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
18004186A
OPTOMETRY LICENSE
IN
Enumeration date
07/29/2019
Last updated
02/28/2023
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