Provider Demographics
NPI:1427323815
Name:DR. STUART M. CLARK, PC
Entity type:Organization
Organization Name:DR. STUART M. CLARK, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STUAT
Authorized Official - Middle Name:M
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:610-685-2733
Mailing Address - Street 1:2209 QUARRY DR
Mailing Address - Street 2:SUITE A-13,14
Mailing Address - City:WEST LAWN
Mailing Address - State:PA
Mailing Address - Zip Code:19609-1155
Mailing Address - Country:US
Mailing Address - Phone:610-685-2733
Mailing Address - Fax:610-685-0939
Practice Address - Street 1:2209 QUARRY DR
Practice Address - Street 2:SUITE A-13,14
Practice Address - City:WEST LAWN
Practice Address - State:PA
Practice Address - Zip Code:19609-1155
Practice Address - Country:US
Practice Address - Phone:610-685-2733
Practice Address - Fax:610-685-0939
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-19
Last Update Date:2012-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000660152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WV0400XEye and Vision Services ProvidersOptometristVision TherapyGroup - Single Specialty