Individual
MICHAEL CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
990 MEDICAL DR STE G3, BRIGHAM CITY, UT 84302
(435) 374-2097
Mailing address
990 MEDICAL DR STE G3, BRIGHAM CITY, UT 84302-3077
(435) 374-2097
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
10841920-9934
UT
152WC0802X
Corneal and Contact Management Optometrist
10841920-9934
UT
Other
Enumeration date
04/16/2018
Last updated
06/04/2018
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