Individual
DR. CHARLES LAMOTTE CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
4811 FAYETTEVILLE ROAD, LUMBERTON, NC 28358
(910) 739-3323
(910) 739-6489
Mailing address
4811 FAYETTEVILLE ROAD, LUMBERTON, NC 28358
(910) 739-3323
(910) 739-6489
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1749
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0923L
BCBS
NC
01
—
2238827
UNITED HEALTHCARE
NC
05
—
890923L
—
NC
Enumeration date
11/15/2006
Last updated
11/02/2012
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