Individual
DR. STEPHEN PAUL CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1668
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0350810001
DMERC
TN
01
—
14981
SPECTERA
TN
01
—
2240022
UNITED HEALTHCARE
TN
01
—
3029708
BLUE CROSS BLUE SHIELD TN
TN
05
—
3940201
—
TN
01
—
9812003
CIGNA
TN
Enumeration date
07/14/2006
Last updated
07/08/2007
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