Provider Demographics
NPI:1467603225
Name:CLARK, ARIENE R (OD)
Entity Type:Individual
Prefix:DR
First Name:ARIENE
Middle Name:R
Last Name:CLARK
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:90 MARKET ST STE 20
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:OR
Mailing Address - Zip Code:97355-2396
Mailing Address - Country:US
Mailing Address - Phone:541-451-1144
Mailing Address - Fax:541-451-1785
Practice Address - Street 1:90 MARKET ST STE 20
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:OR
Practice Address - Zip Code:97355-2396
Practice Address - Country:US
Practice Address - Phone:541-451-1144
Practice Address - Fax:541-451-1785
Is Sole Proprietor?:No
Enumeration Date:2008-10-09
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3286ATI152W00000X
WA60091293152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist