Individual
DR. SELMER MEREDITH CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
201 E 3RD AVE S, CAVALIER, ND 58220
(701) 265-8315
(701) 265-8317
Mailing address
PO BOX 148, 201 E 3RD AVE S, CAVALIER, ND 58220-0148
(701) 265-8315
(701) 265-8317
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
358
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0677790001
MEDICARE DME
ND
05
—
60162
—
ND
01
—
CLA800358
VISION SERVICES INC
ND
Enumeration date
01/14/2008
Last updated
01/13/2010
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