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Individual

KATHRYN M CLARK

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
OD

Contact information

Practice address
2101 JACOB ST. SUITE 201, VALLEY PROF. CENTER SOUTH, WHEELING, WV 26003-6390
(304) 242-9245
(304) 242-6870
Mailing address
617 GLENHITE AVE, WHEELING, WV 26003-6611
(304) 233-1482

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
831-OD
WV

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0149721000
WV
01
DG5587
RAILROAD MEDICARE GROUP OH
OH
01
DG8768
RAILROAD MEDICARE WV GROUP PIN
WV
Enumeration date
12/05/2006
Last updated
05/04/2011
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