Individual
JESSICA A CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
27604 MIDDLEBELT RD, FARMINGTON HILLS, MI 48334-5001
(248) 615-0652
(248) 615-1297
Mailing address
1700 S PARK ST, KALAMAZOO, MI 49001-2779
(269) 342-0003
(269) 342-4284
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
4901004816
MI
152W00000X
Optometrist
6115
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1801151113
—
MI
Enumeration date
07/12/2012
Last updated
12/01/2014
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