Individual
DR. KIM M CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
12000 SE 82ND AVENUE, #2012, PORTLAND, OR 97266-7721
(503) 652-6001
(503) 652-6012
Mailing address
2318 NW EDGEWOOD PL, PORTLAND, OR 97229-7618
(503) 292-4033
(503) 292-2474
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2911ATI
OR
Other
Enumeration date
12/19/2006
Last updated
05/11/2009
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