Provider Demographics
NPI:1225107584
Name:CLARK, ANNE C (MD)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:C
Last Name:CLARK
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:9002 N MERIDIAN ST
Mailing Address - Street 2:SUITE 112
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-5381
Mailing Address - Country:US
Mailing Address - Phone:317-843-9005
Mailing Address - Fax:317-580-0443
Practice Address - Street 1:9002 N MERIDIAN ST
Practice Address - Street 2:SUITE 112
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-5381
Practice Address - Country:US
Practice Address - Phone:317-843-9005
Practice Address - Fax:317-580-0443
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2008-01-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN01031207207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000538214OtherBLUE CROSS/BLUE SHIELD
IN100326110Medicaid
IN797890BMedicare PIN
IND94967Medicare UPIN
IN253740BMedicare PIN