Individual
DR. KATHLEEN A. CLARY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
200 MOSAIC CIR, POOLER, GA 31322-5025
(912) 348-4584
Mailing address
200 MOSAIC CIR, POOLER, GA 31322-5025
(912) 348-4584
Taxonomy
Speciality
Code
Description
License number
State
152WC0802X
Corneal and Contact Management Optometrist
Primary
0618000373
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
D19772
—
SC
01
—
SCB632E499
SC MEDICARE
SC
Enumeration date
02/11/2006
Last updated
11/30/2022
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