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Individual

DR. DARYLE L CLARK

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
OD

Contact information

Practice address
312 E LAKEWAY RD, GILLETTE, WY 82718-6329
(307) 687-7353
(307) 686-1052
Mailing address
312 E LAKEWAY RD, GILLETTE, WY 82718-6329
(307) 686-2010
(307) 686-1052

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
191T
WY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
104289100
WY
Enumeration date
09/07/2005
Last updated
12/05/2015
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