Provider Demographics
NPI:1346433919
Name:DR. ANDREW CLARKE & ASSOC.
Entity Type:Organization
Organization Name:DR. ANDREW CLARKE & ASSOC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRACTITIONER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:CLARKE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:901-233-7677
Mailing Address - Street 1:217 STONEWALL ST
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38112-5113
Mailing Address - Country:US
Mailing Address - Phone:901-276-3538
Mailing Address - Fax:901-722-3538
Practice Address - Street 1:3358 AUSTIN PEAY HWY
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38128
Practice Address - Country:US
Practice Address - Phone:901-382-9534
Practice Address - Fax:901-382-9569
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-27
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1178152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
3597110Medicare PIN