Individual
CHARLES A CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
212 N FRANKLIN ST, CORYDON, IA 50060-1328
(641) 774-5819
(641) 774-8415
Mailing address
212 N FRANKLIN ST, PO BOX 611, CORYDON, IA 50060-1328
(641) 774-5819
(641) 774-8415
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
01637
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3162669
—
IA
01
—
410045287
RAILROAD MEDICARE
IA
Enumeration date
08/18/2005
Last updated
07/12/2016
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