Provider Demographics
NPI:1417927336
Name:CLARK, HERBERT C (OD)
Entity Type:Individual
Prefix:DR
First Name:HERBERT
Middle Name:C
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 1:65 ROCHESTER HILL RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03867-3231
Mailing Address - Country:US
Mailing Address - Phone:603-332-8569
Mailing Address - Fax:603-332-5546
Practice Address - Street 1:65 ROCHESTER HILL RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03867-3231
Practice Address - Country:US
Practice Address - Phone:603-332-8569
Practice Address - Fax:603-332-5546
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2008-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHNH0292152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH80587786Medicaid
NH0216900001Medicare NSC
NH80587786Medicaid