Dr. Jackie Harold Clark Sr., O.D.
Optometrist in Broken Arrow, OK. Individual provider (NPI-1).
NPI number1790769065
StatusActive
Last updated in NPPESJun 10, 2011
Details
- NPI
- 1790769065
- Entity type
- Individual (NPI-1)
- Name
- Dr. Jackie Harold Clark Sr.
- Credential
- O.D.
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Dec 1, 2005
- Last updated
- Jun 10, 2011
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 152W00000X | Optometrist | 1129 | OK | Yes |
Practice location
1805 N 13th StBroken Arrow, OK 74012-8256
Phone 918-872-1833
Mailing address
1805 N 13th StBroken Arrow, OK 74012-8256
Phone 918-872-1833
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All 44 Optometrist providers in Broken Arrow · All 2,347 providers in Broken Arrow
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