Clark, Jack Douglas
Clark, Jack Douglas is an sole proprietor health care provider with primary practice located at 7112 N Fresno St Suite 100, Fresno CA 93720-2940. He recently has only one registered license in Allopathic & Osteopathic Physicians / Ophthalmology, which is considered as his primary health care specialty. Clark, Jack Douglas can be contacted via phone (559) 439-1620.Contact Information
Primary practice address
7112 N Fresno St Suite 100
Fresno CA 93720-2940
Phone: (559) 439-1620
Fax: (559) 432-6579
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Ophthalmology | 207W00000X | G56196 | California |
Profile Details
| NPI number | 1265571608 |
|---|---|
| LBN Legal business name | Clark, Jack Douglas |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Feb 5th, 2007 |
| Last updated | Jul 8th, 2007 - about 17 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 | 1265571608 | NPPES |
| California | MEDICAID | 00G561960 |
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