Individual
EDWARD OWEN CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LDO,ABOC
Contact information
Practice address
12000 IRON BRIDGE RD, CHESTER, VA 23831-1459
(804) 768-1273
Mailing address
12000 IRON BRIDGE RD, CHESTER, VA 23831-1459
(804) 768-1273
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
1101003836
VA
Other
Enumeration date
12/08/2022
Last updated
12/08/2022
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