Provider Demographics
NPI:1164478392
Name:CLARKE, DAVID ERIC (OD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:ERIC
Last Name:CLARKE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2565 CEANOTHUS AVE 155
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95973-7615
Mailing Address - Country:US
Mailing Address - Phone:530-899-3939
Mailing Address - Fax:
Practice Address - Street 1:2565 CEANOTHUS AVE # 155
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95973-7615
Practice Address - Country:US
Practice Address - Phone:530-899-3939
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11302152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA912197331OtherBLUE CROSS
CASD0113020Medicaid
CASD0113020OtherBLUE SHIELD
CASD0113020OtherBLUE SHIELD
CAU86448Medicare UPIN
CAMC1082786OtherDEA