Individual
DR. JASON M CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
101 CONLEY RD, COLUMBIA, MO 65201-6465
(573) 875-1126
Mailing address
101 CONLEY RD, COLUMBIA, MO 65201-6465
(573) 875-1126
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2012021505
MO
Other
Enumeration date
09/05/2012
Last updated
09/05/2012
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