Provider Demographics
NPI:1235291915
Name:CLARK, MANAY (OD)
Entity Type:Individual
Prefix:DR
First Name:MANAY
Middle Name:
Last Name:CLARK
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:MANAY
Other - Middle Name:
Other - Last Name:POOL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:PO BOX 203
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35201-0203
Mailing Address - Country:US
Mailing Address - Phone:205-913-8747
Mailing Address - Fax:
Practice Address - Street 1:5335 HIGHWAY 280
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35242-5317
Practice Address - Country:US
Practice Address - Phone:205-980-0841
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS715-TA340152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALU17584Medicare UPIN