Provider Demographics
NPI:1811084528
Name:CLARK & COVERT OD PC
Entity type:Organization
Organization Name:CLARK & COVERT OD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOHER
Authorized Official - Middle Name:COVERT
Authorized Official - Last Name:R
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:434-973-5361
Mailing Address - Street 1:441 WESTFIELD RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22901-1643
Mailing Address - Country:US
Mailing Address - Phone:434-973-5361
Mailing Address - Fax:434-973-6925
Practice Address - Street 1:441 WESTFIELD RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22901-1643
Practice Address - Country:US
Practice Address - Phone:434-973-5361
Practice Address - Fax:434-973-6925
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0435020001Medicare NSC
VAC03169Medicare PIN