Individual
PHILIP CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LDO
Contact information
Practice address
4201 N 16TH ST, 160, PHOENIX, AZ 85016-5347
(602) 277-5007
Mailing address
4201 N 16TH ST, 160, PHOENIX, AZ 85016-5347
(602) 277-5007
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
417
AZ
Other
Enumeration date
07/21/2014
Last updated
07/21/2014
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