Clark, Jacob A
Clark, Jacob A is an sole proprietor health care provider with primary practice located at 411 N Washington St , Alexandria VA 22314-2311. He recently has only one registered license in Allopathic & Osteopathic Physicians / Ophthalmology, which is considered as his primary health care specialty. Clark, Jacob A can be contacted via phone (703) 548-5588.Contact Information
Primary practice address
411 N Washington St
Alexandria VA 22314-2311
Phone: (703) 548-5588
Fax: (703) 549-1599
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Ophthalmology | 207W00000X | 0101041044 | Virginia |
Profile Details
| NPI number | 1164464806 |
|---|---|
| LBN Legal business name | Clark, Jacob A |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Jun 10th, 2006 |
| Last updated | Jan 21st, 2010 - about 15 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 | 1164464806 | NPPES |
| Virginia | MEDICAID | 6375570 |
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