Provider Demographics
NPI:1396901674
Name:CLARK-WELLS, CHRISTY MICHELLE (OD)
Entity type:Individual
Prefix:DR
First Name:CHRISTY
Middle Name:MICHELLE
Last Name:CLARK-WELLS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:219 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PARAGOULD
Mailing Address - State:AR
Mailing Address - Zip Code:72450-4327
Mailing Address - Country:US
Mailing Address - Phone:870-236-7713
Mailing Address - Fax:870-236-7714
Practice Address - Street 1:219 W MAIN ST
Practice Address - Street 2:
Practice Address - City:PARAGOULD
Practice Address - State:AR
Practice Address - Zip Code:72450-4327
Practice Address - Country:US
Practice Address - Phone:870-236-7713
Practice Address - Fax:870-236-7714
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-05
Last Update Date:2014-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2616152W00000X
MO2008022656152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist