Individual
JACOB A CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
411 N WASHINGTON ST, ALEXANDRIA, VA 22314-2311
(703) 548-5588
(703) 549-1599
Mailing address
2661 RIVA RD STE 1030, ANNAPOLIS, MD 21401-7131
(667) 354-5528
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
0101041044
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6375570
—
VA
Enumeration date
06/10/2006
Last updated
03/21/2026
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