Individual
THOMAS EUGENE CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
1715 S BROADWAY ST, NEW ULM, MN 56073-3751
(507) 354-8531
(507) 359-1124
Mailing address
1715 S BROADWAY ST, NEW ULM, MN 56073-3751
(507) 354-8531
(507) 359-1124
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2902
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1034694
PREFERRED ONE
MN
01
—
171829
UCARE
MN
01
—
2202087
MEDICA
MN
01
—
241M0CL
BLUE CROSS/BLUE SHIELD MN
MN
05
—
747652300
—
MN
01
—
HP38790
HEALTHPARTNERS
MN
Enumeration date
09/23/2005
Last updated
02/27/2015
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