Individual
DONALD R CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
2032 VETERANS BLVD, SUITE A, DUBLIN, GA 31021-3042
(478) 272-3445
(478) 272-4802
Mailing address
1950 OLD GALLOWS RD, SUITE 520, VIENNA, VA 22182-3990
(703) 847-8899
(703) 991-0514
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OPT001315
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000583107F
—
GA
Enumeration date
09/06/2006
Last updated
02/15/2018
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