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Contact Information

MICHAEL CLARK, OD
990 MEDICAL DR STE G3
BRIGHAM CITY, UT84302
 Phone: 435-374-2097
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Optometrist

152W00000X 41 Optometry
 

Corneal and Contact Management

152WC0802X 41 Optometry
Indicates primary specialty

NPI Profile & details for MICHAEL CLARK · (Male)

NPI Number 1558858464
Status Active
Credentials OD (Doctor of Optometry)
Entity Individual
Enumeration date 04/16/2018
Last updated 06/04/2018 - About 8 years ago
Sole proprietor 1 No
Identifiers
  • UT License # 10841920-9934
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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