Organization
DR MICHAEL CLARK OPTOMETRIST PA
Active
Other names
Mt Airy Vision Center
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL CLARK OD (OPTOMETRIST)
(336) 789-9031
Entity
Organization
Contact information
Practice address
602 S RENFRO ST, MOUNT AIRY, NC 27030-4742
(336) 789-9031
(336) 789-8343
Mailing address
602 S RENFRO ST, MOUNT AIRY, NC 27030-4742
(336) 789-9031
(336) 789-8343
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
0884
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
013MW
BCBS OF NC
NC
01
—
1409898
UNITED MINE WORKERS
—
01
—
3739
BLUE MEDICARE HMO
NC
01
—
580000014
PALMETTO GBA--RAILROAD MEDICARE
NC
05
—
89013MW
—
NC
01
—
9203311
VIRGINIA MEDICAID
VA
Enumeration date
10/17/2006
Last updated
03/21/2013
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