Individual
MR. CHRISTOPHER M CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LICENSED OPTICIAN
Contact information
Practice address
1960 ELECTRIC RD, ROANOKE, VA 24018-1601
(540) 776-9722
Mailing address
4833 SHADOW LN, ROANOKE, VA 24019-2563
(540) 562-1380
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
1101 002026
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OP2378
EYEMED VISION CARE
VA
Enumeration date
05/12/2008
Last updated
05/12/2008
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