Organization
LORI J CLARK, O.D. INC, AN OPTOMETRIC CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LORI J CLARK OD (OWNER)
(310) 546-4618
Entity
Organization
Contact information
Practice address
1145 MANHATTAN AVE, MANHATTAN BEACH, CA 90266-5333
(310) 546-4618
(310) 546-9268
Mailing address
1145 MANHATTAN AVE, MANHATTAN BEACH, CA 90266-5333
(310) 546-4618
(310) 546-9268
Taxonomy
Speciality
Code
Description
License number
State
152WC0802X
Corneal and Contact Management Optometrist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
SD0089501
—
CA
Enumeration date
03/05/2019
Last updated
03/05/2019
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