Individual
BRIAN M CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
7635 SHELBYVILLE RD, LOUISVILLE, KY 40222-5409
(502) 423-8500
(502) 339-0571
Mailing address
7635 SHELBYVILLE RD, LOUISVILLE, KY 40222-5409
(502) 423-8500
(502) 339-0571
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1742DT
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100113750
—
KY
01
—
P00850448
RR MEDICARE
—
Enumeration date
07/15/2008
Last updated
10/20/2010
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