Provider Demographics
NPI:1457339285
Name:FIELDEN, CLARK EDWARD (OD)
Entity Type:Individual
Prefix:DR
First Name:CLARK
Middle Name:EDWARD
Last Name:FIELDEN
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 1:2028 W 2220 N
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:UT
Mailing Address - Zip Code:84015-5744
Mailing Address - Country:US
Mailing Address - Phone:801-779-0708
Mailing Address - Fax:
Practice Address - Street 1:2028 W 2220 N
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:UT
Practice Address - Zip Code:84015-5744
Practice Address - Country:US
Practice Address - Phone:801-779-0708
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-03
Last Update Date:2021-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5704014-8904152W00000X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist