Individual
DR. CHARLES LAMOTTE CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
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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