Provider Demographics
NPI:1467589176
Name:CLARK, VEURMER (OD)
Entity Type:Individual
Prefix:DR
First Name:VEURMER
Middle Name:
Last Name:CLARK
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:VERUMER
Other - Middle Name:
Other - Last Name:CLARK-EDWARDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1950 OLD GALLOWS RD STE 520
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-3970
Mailing Address - Country:US
Mailing Address - Phone:703-847-8899
Mailing Address - Fax:571-223-6780
Practice Address - Street 1:6446 LYNDON B JOHNSON FWY
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75240-6407
Practice Address - Country:US
Practice Address - Phone:972-960-2020
Practice Address - Fax:972-960-2063
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2020-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3876TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX752810524OtherTIN
TX752810524OtherTIN
TXT78948Medicare UPIN