NPI 1063612497

Benjamin Reed Clark, OD

Practitioner Optometrist Wisconsin Rapids, WI

Practice location

Address: 1220 Parkwood Dr, Wisconsin Rapids, WI 54494-5488
Phone: (715) 421-2111
Fax: (715) 421-2123
Mailing address: 8614 Westwood Center Dr Fl 9, Vienna, VA 22182-2442

Registered specialties

Optometrist Primary

Eye and Vision Services Providers Taxonomy 152W00000X Licence 3087-035 (WI)

Other Optometrist providers in Wisconsin →

Registry record

NPI: 1063612497
Entity type: Individual
Sex (as registered): Male
NPI issued: 24 Jul 2007
Record last updated: 6 Dec 2022

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.