Provider Demographics
NPI:1992751614
Name:OCKER, CLARK MITCHELL (OD)
Entity type:Individual
Prefix:DR
First Name:CLARK
Middle Name:MITCHELL
Last Name:OCKER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 WYOMISSING BLVD
Mailing Address - Street 2:
Mailing Address - City:WYOMISSING
Mailing Address - State:PA
Mailing Address - Zip Code:19610-2055
Mailing Address - Country:US
Mailing Address - Phone:610-376-6108
Mailing Address - Fax:
Practice Address - Street 1:1665 STATE HILL RD
Practice Address - Street 2:
Practice Address - City:WYOMISSING
Practice Address - State:PA
Practice Address - Zip Code:19610-1900
Practice Address - Country:US
Practice Address - Phone:610-376-1589
Practice Address - Fax:610-374-2808
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001638152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist