Clark, Benjamin Reed
Clark, Benjamin Reed is an individual health care provider with primary practice located at 1220 Parkwood Dr , Wisconsin Rapids WI 54494-5488. He recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as his primary health care specialty. Clark, Benjamin Reed can be contacted via phone (715) 421-2111.Contact Information
Primary practice address
1220 Parkwood Dr
Wisconsin Rapids WI 54494-5488
Phone: (715) 421-2111
Fax: (715) 421-2123
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Eye and Vision Services Providers / Optometrist | 152W00000X | 3087-035 | Wisconsin |
Profile Details
| NPI number | 1063612497 |
|---|---|
| LBN Legal business name | Clark, Benjamin Reed |
| Credentials | Doctor of Optometry (OD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jul 24th, 2007 |
| Last updated | Dec 6th, 2022 - about 3 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1063612497 | NPPES |
| Wisconsin | MEDICAID | 38632200 |
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