Jackie Clark, O.D

ActiveIndividual ProviderOptometry
NPI issued: December 1, 2005

Quick Facts

NPI Number
1790769065
TypeIndividual
StatusActive
SpecialtyOptometry
Taxonomy152W00000X — Optometry
Phone
(918) 872-1833
StateOK

NPI Validation Status: Verified

Valid 10-digit NPI number (1790769065)
Active status confirmed
Verified by CMS NPPES Registry
HIPAA compliant identifier
Enumeration date on file (December 1, 2005)
Data source: CMS NPPES

Provider Overview

JACKIE CLARK, O.D is a Optometry provider based in Broken Arrow, OK who has been registered with CMS since 2005. This NPI is currently Active under CMS NPPES registry.

Provider Details

NPI Number1790769065
Provider TypeIndividual Provider
GenderMale
CredentialO.D
StatusActive
Enumeration DateDecember 1, 2005

Practice Location

CityBroken Arrow
StateOK
ZIP Code74012-8256
Phone(918) 872-1833

Specialties & Licenses

★ Primary
SpecialtyOptometry
Taxonomy Code152W00000X
License StateOK

Mailing Address

CityBroken Arrow
StateOK
ZIP Code74012-8256
Phone(918) 872-1833
Same as practice location

How to Use This NPI

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For Insurance Billing

Use NPI 1790769065 in Box 33 of the CMS-1500 claim form. This number is required by all major insurance carriers to identify the billing provider and process electronic medical claims.

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For Credentialing

Reference NPI 1790769065for provider credential verification. Hospital systems, state licensing boards, and CAQH directories query this number to verify the provider's active clinical status.

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For Patients

Share NPI 1790769065 with your insurance company. If you need to verify out-of-network benefits or file a reimbursement claim, your insurance provider will require this number to process it.

About Optometry

Specialists in Optometry provide expert clinical care within their specific domain, focusing on the diagnosis, treatment, and management of conditions relevant to their field of practice.

📊
95,009
Optometry Providers in the US

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People Also Ask

What is Jackie Clark's NPI number?
Jackie Clark's NPI number is 1790769065, a unique 10-digit identifier issued by the Centers for Medicare & Medicaid Services (CMS).
Is Jackie Clark's NPI currently active?
Yes, Jackie Clark's NPI status is Active as of the latest CMS NPPES database updates.
What does Jackie Clark specialize in?
Jackie Clark specializes in Optometry. The healthcare taxonomy code associated with this specialty is 152W00000X.
Where does Jackie Clark practice?
Jackie Clark practices in Broken Arrow, OK 74012-8256.
When was Jackie Clark's NPI issued?
Jackie Clark's NPI was issued on December 1, 2005.
What is Jackie Clark's provider type?
Jackie Clark is registered as an Individual Provider under CMS NPI Type 1.