Organization
THE CLARK EYE CLINIC, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SPURGEON WILLIAM CLARK III M.D. (OWNER)
(912) 285-2020
Entity
Organization
Contact information
Practice address
502 ISABELLA ST, WAYCROSS, GA 31501-3638
(912) 285-2020
(912) 285-8112
Mailing address
PO BOX 2009, WAYCROSS, GA 31502-2009
(912) 285-2020
(912) 285-8112
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
24916
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00264547B3
—
GA
01
—
024581
BLUE CROSS BLUE SHIELD
GA
01
—
CF4836
RAILROAD MEDICARE
GA
Enumeration date
03/19/2007
Last updated
01/25/2010
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