Organization
ROBERT T CLARK MD PC
Active
Other names
Clark Tait Eye Center, Clark Eye Center
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROBERT THOMAS CLARK MD (PRESIDENT)
(810) 844-7744
Entity
Organization
Contact information
Practice address
7575 GRAND RIVER RD, SUITE 111, BRIGHTON, MI 48114-9309
(810) 844-7744
(810) 844-7725
Mailing address
7575 WEST GRAND RIVER, SUITE 111, BRIGHTON, MI 48114-9390
(810) 844-7744
(810) 844-7725
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
4301040778
MI
332H00000X
Eyewear Supplier
4301040778
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0297200001
DME SUPPLIER
MI
01
—
0D710210
GRP # BCBS
MI
05
—
102681557
—
MI
Enumeration date
12/28/2006
Last updated
06/15/2021
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