Individual
DR. STEPHEN E. CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
28370 KENSINGTON LN, SUITE A, PERRYSBURG, OH 43551-4163
(419) 874-3125
(419) 874-8606
Mailing address
28370 KENSINGTON LN, SUITE A, PERRYSBURG, OH 43551-4163
(419) 874-3125
(419) 874-8606
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
01041459A
IN
207W00000X
Ophthalmology Physician
Primary
35063695
OH
207W00000X
Ophthalmology Physician
4301069901
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000281826
ANTHEM BLUE CROSS/SHIELD
OH
01
—
02272
PARAMOUNT HEALTH CARE
OH
05
—
0292679
—
OH
01
—
5814164
AETNA
OH
Enumeration date
05/24/2005
Last updated
05/10/2012
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