Individual
JEFFREY J CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
845 WATER AVE, HILLSBORO, WI 54634-6213
(608) 489-2451
Mailing address
1836 SOUTH AVE, LA CROSSE, WI 54601-5429
(608) 782-7300
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1574
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
38502900
—
WI
Enumeration date
06/14/2005
Last updated
02/01/2016
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