Gregory Clark, O.D., Inc.

LBN: Gregory Clark, O.D., Inc.
Gregory Clark, O.D., Inc. is an health care organization with primary practice located at 12547 Riverdale Blvd Nw Costco Optical Department, Coon Rapids MN 55448-6708. The organization recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as the primary health care specialty. Gregory Clark, O.D., Inc. can be contacted via phone (763) 712-7761, or through Clark, Gregory Alexander via phone (612) 703-0298.

Contact Information

Primary practice address
12547 Riverdale Blvd Nw Costco Optical Department Coon Rapids MN 55448-6708
Phone: (763) 712-7761
Fax: (763) 712-7787
Website:
Map and Directions
Authorized official contact:
Name: Clark, Gregory Alexander Doctor of Optometry (OD)
Phone: (612) 703-0298

Health care specialties

SpecialtyCodeLicense #State
Eye and Vision Services Providers / Optometrist 152W00000X 2806 Minnesota

Profile Details

NPI number 1801965504
LBN Legal business name Gregory Clark, O.D., Inc.
DBA Doing business as
Authorized official Clark, Gregory Alexander Doctor of Optometry (OD)
Entity Organization
Organization subpart 1 No
Enumeration date Nov 7th, 2006
Last updated Nov 29th, 2012 - about 13 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1801965504 NPPES
Minnesota MEDICAID 1634747-00

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