Provider Demographics
NPI:1598944654
Name:CLARK EYE CARE CENTER
Entity Type:Organization
Organization Name:CLARK EYE CARE CENTER
Other - Org Name:LENTSCH EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:J
Authorized Official - Last Name:LENTSCH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:352-732-0046
Mailing Address - Street 1:810 NE 25TH AVE
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34470-6335
Mailing Address - Country:US
Mailing Address - Phone:352-732-0046
Mailing Address - Fax:
Practice Address - Street 1:810 NE 25TH AVE
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34470
Practice Address - Country:US
Practice Address - Phone:352-732-0046
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-25
Last Update Date:2019-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC5388152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL086895700Medicaid
DC2053OtherMEDICARE NSC
FL086895700Medicaid
K1714Medicare PIN