Individual
DR. SELMER MEREDITH CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OD
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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