Individual
MR. NICKOLAS WILSON CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
122 TAZEWELL ST, PEARISBURG, VA 24134
(540) 921-3921
(540) 921-1328
Mailing address
122 TAZEWELL ST, PEARISBURG, VA 24134-1632
(540) 921-3921
(540) 921-1328
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
0618002202
VA
Other
Enumeration date
10/09/2007
Last updated
07/06/2018
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