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Contact Information

DOUGLAS R CLARK, OD
446 N STATE ROAD 198
SALEM, UT84653
 Phone: 801-368-5987
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Optometrist

152W00000X 41 Optometry
Indicates primary specialty

NPI Profile & details for DOUGLAS R CLARK · (Male)

NPI Number 1487008603
Status Active
Credentials OD (Doctor of Optometry)
Entity Individual
Enumeration date 04/14/2016
Last updated 05/22/2019 - About 7 years ago
Sole proprietor 1 Yes
Identifiers
  • UT License # 9844583-9934
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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