Individual
DR. CHAD CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
1205 S FIVE MILE RD, BOISE, ID 83709-1304
(208) 322-8381
Mailing address
1205 S FIVE MILE RD, BOISE, ID 83709-1304
(208) 322-8381
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
ODP-100308
ID
Other
Enumeration date
06/25/2014
Last updated
11/14/2022
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