Individual
MR. RAYMOND A KLARK JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OPTICIAN
Contact information
Practice address
236 PINEWOODS AVE, TONAWANDA, NY 14150-7068
(716) 836-1909
(716) 434-7809
Mailing address
236 PINEWOODS AVE, TONAWANDA, NY 14150-7068
(716) 836-1909
(716) 434-7809
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
4077
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00707231
—
NY
Enumeration date
04/08/2007
Last updated
07/09/2007
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