Individual
SCOTT CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
491 RANTOUL ST, BEVERLY, MA 01915-3231
(508) 922-4732
Mailing address
491 RANTOUL ST, BEVERLY, MA 01915-3231
(508) 837-3790
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
3055
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
003055
TUFTS
MA
05
—
0353442
—
MA
01
—
40857
FALLON
MA
01
—
DM9725
HPHC
MA
01
—
W15719
BCBS
MA
Enumeration date
11/29/2006
Last updated
04/20/2020
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