Individual
DR. GARY L CLARKE
Active
Individual
DR. GARY L CLARKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
3220
OH
152W00000X
Optometrist
641-D
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0150144000
—
WV
05
—
0345700
—
OH
01
—
1010821
WORKERS' COMP WV
WV
01
—
3110671970
WORKERS' COMP OH
OH
01
—
9263881
MEDICARE PTAN
OH
Enumeration date
04/03/2006
Last updated
07/11/2012
Update your record
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