Individual
BENJAMIN REED CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
1220 PARKWOOD DR, WISCONSIN RAPIDS, WI 54494-5488
(715) 421-2111
(715) 421-2123
Mailing address
8614 WESTWOOD CENTER DR FL 9, VIENNA, VA 22182-2442
(703) 847-8899
(571) 223-6780
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
3087-035
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
38632200
—
WI
Enumeration date
07/24/2007
Last updated
12/06/2022
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