Individual
DR. ANNA J CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
4491 BENT BROTHERS BLVD., COLORADO CITY, CO 81019-9366
(719) 676-3937
(719) 676-4390
Mailing address
PO BOX 19366, COLORADO CITY, CO 81019-9366
(719) 676-3937
(719) 676-4390
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2855
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00685232
—
CO
Enumeration date
07/20/2011
Last updated
12/20/2016
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