Individual
THOMAS EDWARD CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
3672 W SOUTH JORDAN PKWY STE 103, SOUTH JORDAN, UT 84009-7172
(801) 810-1060
Mailing address
458 E 200 N, PLEASANT GROVE, UT 84062-2821
(385) 439-7172
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
11777686-9934
UT
152WP0200X
Pediatric Optometrist
11777686-9934
UT
152WS0006X
Sports Vision Optometrist
11777686-9934
UT
152WV0400X
Vision Therapy Optometrist
11777686-9934
UT
Other
Enumeration date
06/02/2020
Last updated
06/02/2020
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