Provider Demographics
NPI:1427700012
Name:ROGER CLARK HEARING CENTERS
Entity type:Organization
Organization Name:ROGER CLARK HEARING CENTERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:HIS
Authorized Official - Phone:806-317-9033
Mailing Address - Street 1:4555 E UNIVERSITY BLVD STE C7
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79762-8137
Mailing Address - Country:US
Mailing Address - Phone:432-444-5200
Mailing Address - Fax:
Practice Address - Street 1:4555 E UNIVERSITY BLVD STE C7
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79762-8137
Practice Address - Country:US
Practice Address - Phone:432-444-5200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-25
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX80241OtherHEARING INSTRUMENT SPECIALIST
TX80214OtherHEARING INSTRUMENT SPECIALIST