Clark, Lori J

Clark, Lori J is an sole proprietor health care provider with primary practice located at 1145 Manhattan Ave , Manhattan Beach CA 90266-5333. She recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as her primary health care specialty. Clark, Lori J can be contacted via phone (310) 546-4618.

Contact Information

Primary practice address
1145 Manhattan Ave Manhattan Beach CA 90266-5333
Phone: (310) 546-4618
Fax: (310) 546-9268
Website:
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Health care specialties

SpecialtyCodeLicense #State
Eye and Vision Services Providers / Optometrist 152W00000X OP8950T California

Profile Details

NPI number 1073575213
LBN Legal business name Clark, Lori J
Credentials Doctor of Optometry (OD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Apr 4th, 2006
Last updated Nov 19th, 2012 - about 12 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1073575213 NPPES
California MEDICAID SD0089501

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