Individual
STEPHEN BRENT CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
8390 NORTH HWY 27, ROCK SPRING, GA 30739-2103
(706) 375-1720
(706) 375-1729
Mailing address
8390 NORTH HWY 27, ROCK SPRING, GA 30739-2103
(706) 375-1720
(706) 375-1729
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
OD002478
TN
152W00000X
Optometrist
Primary
OPT002352
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
194699738A
—
GA
01
—
1952300832
BCBS
GA
01
—
1952569279
GROUP NPI
GA
01
—
26-2355581
UHC
GA
01
—
511G700557
MEDICARE
GA
Enumeration date
07/21/2005
Last updated
07/22/2010
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