DR. JACKIE HAROLD CLARK SR.


Address: 1805 N 13th St, Broken Arrow, OK 74012-8256
Phone: 9188721833

DR. JACKIE HAROLD CLARK SR. (NPI# 1790769065) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1790769065
Entity Type Individual
Full Name DR. JACKIE HAROLD CLARK SR.
Credential O.D.
Practice Address 1805 N 13th St
Broken Arrow
OK 74012-8256
Practice Telephone 9188721833
Mailing Telephone 9188721833
Enumeration Date 2005-12-01
Last Update Date 2011-06-10
Gender Code M
Is Sole Proprietor Y

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 152W00000X Optometrist 1129 OK Eye and Vision Services Providers

Other Provider Identifier

State Issuer Identifier Type Code
OK 100761100A 05

Other Providers JACKIE CLARK

NPI Name Taxonomy Address Enumeration
1124474457 Jackie Clark Occupational Therapist 11472 Walden Loop, Parrish, FL 34219-7565 2016-05-05
1417951484 Jackie Leah Clark Audiologist 601 S Tool Dr, Tool, TX 75143-1959 2005-06-08
1467874107 Jackie Clark Counselor 6130 Elton Ave, Las Vegas, NV 89107-2538 2014-01-15

Office Location

Street Address 1805 N 13TH ST
City BROKEN ARROW
State OK
Zip Code 74012-8256

Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1154949139 Bonnie Jordan James Pharmacist 915 E Kenosha St, Broken Arrow, OK 74012 2020-07-07
1548814874 Flawless Smile Dentistry of Ba Pllc Dentist 2319 N. 9th Street, Broken Arrow, OK 74012 2019-07-25
1780236653 Carefirst Pharmacy Inc. Pharmacy 2530 N. Elm Pl., Broken Arrow, OK 74012 2019-07-11
1043871213 Stacy Lynn Mitchell Counselor 2035 W. Houson St., Suite A, Broken Arrow, OK 74012 2019-06-27
1497319297 Sara Hart Internal Medicine 420 W. Stone Wood Drive, Broken Arrow, OK 74012 2019-04-26
1699262386 Fulps Family Eye Care, LLC Optometrist 3300 S Aspen Ave Ste D, Broken Arrow, OK 74012 2018-04-18
1598284358 Stephanie Sue Mcquarters Clinical Medical Laboratory 1840 South Lion Avenue, Broken Arrow, OK 74012 2017-09-13
1477072460 Kama Rae Gettings Nurse Practitioner 4623 W. Kenosha St, Broken Arrow, OK 74012 2017-09-12
1689196727 Kristen Sherie' Snyder Case Manager/Care Coordinator 1324 North Umbrella Avenue, Broken Arrow, OK 74012 2017-07-11
1699216754 Hillside Wellness Plllp Chiropractor 2311 N 9th St, Suite 101, Broken Arrow, OK 74012 2017-03-09
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Taxonomy Information

Taxonomy Code 152W00000X
Grouping Eye and Vision Services Providers
Classification Optometrist

Taxonomy Definition

Doctors of optometry (ODs) are the primary health care professionals for the eye. Optometrists examine, diagnose, treat, and manage diseases, injuries, and disorders of the visual system, the eye, and associated structures as well as identify related systemic conditions affecting the eye. An optometrist has completed pre-professional undergraduate education in a college or university and four years of professional education at a college of optometry, leading to the doctor of optometry (O.D.) degree. Some optometrists complete an optional residency in a specific area of practice. Optometrists are eye health care professionals state-licensed to diagnose and treat diseases and disorders of the eye and visual system.
Notes: Source: American Optometric Association (AOA), approved by the AOA’s Board of Trustees, June 21, 2005. [7/1/2006: definition modified]

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1992330534 Janet Poole Naguib Optometrist 4008 S Elm Pl Ste A, Broken Arrow, OK 74011-2021 2020-03-04
1699262386 Fulps Family Eye Care, LLC Optometrist 3300 S Aspen Ave Ste D, Broken Arrow, OK 74012 2018-04-18
1942605324 Alliance Vision Services Pllc Optometrist 2816 W Imperial St, Broken Arrow, OK 74011-6461 2014-10-28
1649685488 Anji Brassfield O.d. P.C. Optometrist 307 W Washington St, Broken Arrow, OK 74012-6448 2014-06-30
1245643881 Njoy Tulsa LLC Optometrist 1601 S Eucalyptus Ave, Suite 200, Broken Arrow, OK 74012-6053 2014-06-10
1447671664 Ba Eye Site, Pllc Optometrist 2500 W New Orleans St, Broken Arrow, OK 74011-1574 2013-12-16
1508190893 Scott M Hibbets Od PC Corp Optometrist 433 Stone Wood Dr, Broken Arrow, OK 74012-1026 2009-09-20
1932355112 Anderson Eyecare PC Optometrist 2001 S Elm Pl Ste B, Broken Arrow, OK 74012-7025 2008-08-07
1902065972 Brad Wells Od PC Inc Optometrist 2142 W Detroit St, Broken Arrow, OK 74012 2008-06-05
1811186976 Stacey Murrell, Od PC Inc Optometrist 1406 S Aspen Ave, Broken Arrow, OK 74012-4807 2007-10-15
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Competitor

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City BROKEN ARROW
Zip Code 74012

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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