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Contact Information

JACOB D CLARK, OD
2826 ROSS CLARK CIR STE 102
DOTHAN, AL36301-2017
 Phone: 334-793-2633
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Optometrist

152W00000X 41 Optometry
Indicates primary specialty

NPI Profile & details for JACOB D CLARK · (Male)

NPI Number 1760049068
Status Active
Credentials OD (Doctor of Optometry)
Entity Individual
Enumeration date 05/22/2019
Last updated 07/25/2025 - About 10 months ago
Sole proprietor 1 No
Identifiers
  • AL License # S-E20-TA-B53
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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