Benjamin Reed Clark O.D.

NPI 1063612497 - Optometrist - 152W00000X

NPI Details
NPI 1063612497
Gender Male
Enumeration Date 07/24/2007
Last Updated 11/14/2011
Entity Type Individual
Active Over 9 years ago
Practice Location
2801 W KK RIVER PKWY
SUITE 170
MILWAUKEE WI, 53215-3669, US
Phone (414) 385-8725
Fax (414) 385-8730
Business Location
2801 W KK RIVER PKWY
SUITE 170
MILWAUKEE WI, 53215-3669, US
Phone (414) 385-8725
Fax (414) 385-8730
Toxanomy
Taxonomy Code 152W00000X
License State Wisconsin
License Number 3087-035
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According to our database, Benjamin Reed Clark O.D. NPI is 1063612497, taxonomy code is 152W00000X and license number is 3087-035, license state is located at Wisconsin. Benjamin Reed Clark O.D. physically located at 2801 W Kk River Pkwy, Milwaukee WI, 53215-3669. NPI Number Benjamin Reed Clark O.D. has the Individual type.

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1063612497 NPI number is provided on an as is basis without warranty of any kind. 1063612497 is maintained by the National Plan & Provider Enumeration System. The contents of Benjamin Reed Clark O.D. are for informational purposes only.