Individual
DR. ORVILLE MAYO CLARK III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
237 SECOND STREET, PIKEVILLE, KY 41501
(606) 437-9955
Mailing address
PO BOX 632, PIKEVILLE, KY 41502-0632
(606) 437-9955
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
0618001530
VA
152W00000X
Optometrist
Primary
0827DT
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
77008274
—
KY
Enumeration date
02/20/2007
Last updated
07/08/2007
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