Organization
SHANNON L CLARK O D P A
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SHANNON L W CLARK LEITENBAUER O.D. (PRESIDENT/OWNER)
(772) 465-6616
Entity
Organization
Contact information
Practice address
2305 OLEANDER BLVD, FORT PIERCE, FL 34982-5830
(772) 465-6616
Mailing address
2305 OLEANDER BLVD, FORT PIERCE, FL 34982-5830
(772) 465-6616
Taxonomy
Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
OPC 0003067
FL
Other
Enumeration date
12/26/2007
Last updated
07/29/2008
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