Provider Demographics
NPI:1891842548
Name:WELSH, CLARK T (OD)
Entity Type:Individual
Prefix:
First Name:CLARK
Middle Name:T
Last Name:WELSH
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1635 DIVISADERO ST STE 400
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115-3043
Mailing Address - Country:US
Mailing Address - Phone:415-833-2020
Mailing Address - Fax:415-833-2609
Practice Address - Street 1:1635 DIVISADERO ST STE 400
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-3043
Practice Address - Country:US
Practice Address - Phone:415-833-2020
Practice Address - Fax:415-833-2609
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9121152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist