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MR. STEVEN JAMES CLARK LD0001859

Optician >> Technician/Technologist >> Eye and Vision Services Providers

Registrant NPI Number: 1619197779

Individual Registrant:
MR. STEVEN JAMES CLARK LD0001859
Gender: M
Not Sole Proprietor

Location and contact information for practice:
4292 GRAY HWY SUITE A GRAY, GA 31032 US
Tel: 478-986-2384  Fax: 478-986-2301

Contact information for business:
4292 GRAY HWY SUITE A GRAY, GA 31032 US
Tel: 478-986-2384  Fax: 478-986-2301

Registration Information:
NPI: 1619197779
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y156FX1800XEye and Vision Services Providers
Technician/Technologist
Optician
GALD0001859

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType




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