Provider Demographics
NPI:1568564896
Name:CLARK, CHRISTOPHER N (OD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:N
Last Name:CLARK
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:2548 MAJESTIC WAY
Mailing Address - Street 2:
Mailing Address - City:BULLHEAD CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86442-8767
Mailing Address - Country:US
Mailing Address - Phone:528-758-1450
Mailing Address - Fax:528-758-1683
Practice Address - Street 1:2840 HIGHWAY 95 STE 505
Practice Address - Street 2:
Practice Address - City:BULLHEAD CITY
Practice Address - State:AZ
Practice Address - Zip Code:86442-7793
Practice Address - Country:US
Practice Address - Phone:928-758-1450
Practice Address - Fax:928-758-1683
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1528152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist