Clark, Scott
Clark, Scott is an sole proprietor health care provider with primary practice located at 491 Rantoul St , Beverly MA 01915-3231. He recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as his primary health care specialty. Clark, Scott can be contacted via phone (508) 922-4732.Contact Information
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Eye and Vision Services Providers / Optometrist | 152W00000X | 3055 | Massachusetts |
Profile Details
| NPI number | 1205903754 |
|---|---|
| LBN Legal business name | Clark, Scott |
| Credentials | Doctor of Optometry (OD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Nov 29th, 2006 |
| Last updated | Apr 20th, 2020 - about 5 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 | 1205903754 | NPPES |
| Massachusetts | Other | 40857 | FALLON |
| Massachusetts | Other | 003055 | FALLON |
| Massachusetts | Other | W15719 | FALLON |
| Massachusetts | Other | DM9725 | FALLON |
| Massachusetts | MEDICAID | 0353442 | FALLON |
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