Individual
DOUGLAS ROBERT CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
446 N STATE ROAD 198, SALEM, UT 84653
(801) 368-5987
Mailing address
446 N STATE ROAD 198, SALEM, UT 84653-4605
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
9844583-9934
UT
Other
Enumeration date
04/14/2016
Last updated
05/22/2019
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