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).
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 |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 152W00000X | Optometrist | 1129 | OK | Eye and Vision Services Providers |
State | Issuer | Identifier | Type Code |
---|---|---|---|
OK | 100761100A | 05 |
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 |
Street Address |
1805 N 13TH ST |
City | BROKEN ARROW |
State | OK |
Zip Code | 74012-8256 |
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 |
Find all providers in zip 74012 |
Taxonomy Code | 152W00000X |
Grouping | Eye and Vision Services Providers |
Classification | Optometrist |
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] |
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 |
Find all providers in BROKEN ARROW |
City | BROKEN ARROW |
Zip Code | 74012 |
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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.