Individual
JACK DOUGLAS CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
7112 N FRESNO ST, SUITE 100, FRESNO, CA 93720-2940
(559) 439-1620
(559) 432-6579
Mailing address
7112 N FRESNO ST, SUITE 100, FRESNO, CA 93720-2940
(559) 439-1620
(559) 432-6579
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
G56196
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G561960
—
CA
Enumeration date
02/05/2007
Last updated
07/08/2007
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