Individual
DR. KATHLEEN J CLARK-GELBURD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OPTOMETRIST
Contact information
Practice address
400 S MAGNOLIA AVE, WAYNESBORO, VA 22980-3648
(540) 949-7126
(540) 943-6170
Mailing address
1950 OLD GALLOWS RD STE 520, VIENNA, VA 22182-3970
(703) 847-8899
(866) 795-4020
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
0618000978
VA
152WC0802X
Corneal and Contact Management Optometrist
0618000978
VA
152WP0200X
Pediatric Optometrist
0618000978
VA
152WV0400X
Vision Therapy Optometrist
0618000978
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
033512
ANTHEM-VIRGINIA
VA
Enumeration date
06/20/2006
Last updated
03/17/2018
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