Organization
BREL CLARK,O.D.,P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BREL CLARK O.D. (OWNER/OPTOMETRIST)
(706) 405-7308
Entity
Organization
Contact information
Practice address
5279 WHITTLESEY BLVD STE 100, COLUMBUS, GA 31909-3073
(706) 405-7308
(706) 324-4939
Mailing address
PO BOX 4259, COLUMBUS, GA 31914-0259
(706) 405-7308
(706) 324-4939
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OPT000940
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000229215G
—
GA
Enumeration date
08/15/2016
Last updated
08/15/2016
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