Provider Demographics
NPI:1700212438
Name:THOMAS H CLARK PC
Entity Type:Organization
Organization Name:THOMAS H CLARK PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:HAROLD
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:802-862-1947
Mailing Address - Street 1:33 BLAIR PARK RD
Mailing Address - Street 2:#101
Mailing Address - City:WILLISTON
Mailing Address - State:VT
Mailing Address - Zip Code:05495-7587
Mailing Address - Country:US
Mailing Address - Phone:802-862-1947
Mailing Address - Fax:802-878-4874
Practice Address - Street 1:33 BLAIR PARK RD
Practice Address - Street 2:#101
Practice Address - City:WILLISTON
Practice Address - State:VT
Practice Address - Zip Code:05495-7587
Practice Address - Country:US
Practice Address - Phone:802-862-1947
Practice Address - Fax:802-878-4874
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-26
Last Update Date:2014-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty