Provider Demographics
NPI:1235299389
Name:CLARK, STUART MITCHELL (OD)
Entity Type:Individual
Prefix:DR
First Name:STUART
Middle Name:MITCHELL
Last Name:CLARK
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 1:508 MAPLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:DOUGLASSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19518-1200
Mailing Address - Country:US
Mailing Address - Phone:610-385-6252
Mailing Address - Fax:
Practice Address - Street 1:2209 QUARRY DR
Practice Address - Street 2:SUITE A - 13, 14
Practice Address - City:WEST LAWN
Practice Address - State:PA
Practice Address - Zip Code:19609-1155
Practice Address - Country:US
Practice Address - Phone:610-685-2733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000660152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WV0400XEye and Vision Services ProvidersOptometristVision Therapy