Provider Demographics
NPI:1356334734
Name:CLARK, STEVEN (OD)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:
Last Name:CLARK
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:433 SE JUNIPER AVE
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97080-7870
Mailing Address - Country:US
Mailing Address - Phone:503-449-1678
Mailing Address - Fax:
Practice Address - Street 1:8700 NE VANCOUVER MALL DR STE 168
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98662-7922
Practice Address - Country:US
Practice Address - Phone:360-253-3663
Practice Address - Fax:360-944-6090
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2023-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2307-AT152W00000X
WA60589963152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist