Jackie Harold Clark Sr., O.D.
Optometrist · Broken Arrow, OK
Practice location
1805 N 13TH StBroken Arrow, OK 74012-8256
- Phone
- (918) 872-1833
NPI record
- NPI
- 1790769065
- Entity type
- Individual (Type 1)
- Enumeration date
- December 1, 2005
- Last updated
- June 10, 2011
- Sole proprietor
- Yes
Specialties & taxonomy codes
| Taxonomy | Code | License | State |
|---|---|---|---|
| Optometrist Primary | 152W00000X |
1129 | OK |
About Dr. Clark
Jackie Harold Clark Sr., O.D. is a healthcare provider registered in the NPI registry with the primary taxonomy Optometrist (code 152W00000X). The practice location is 1805 N 13TH St, Broken Arrow, OK 74012-8256. The NPI number 1790769065 was assigned on December 1, 2005 and the record was last updated on June 10, 2011.
Dr. Clark lists a license in the registry: #1129 (OK) for Optometrist. License numbers are self-reported to NPPES; verify them with the state licensing board.
Frequently asked questions
What is the NPI number of Jackie Harold Clark Sr., O.D.?
The NPI number is 1790769065.
What is the phone number of Dr. Clark?
The phone number listed for the practice location is (918) 872-1833.
Where is Dr. Clark located?
1805 N 13TH St, Broken Arrow, OK 74012-8256.
What is the taxonomy code for Dr. Clark?
The primary taxonomy code is 152W00000X – Optometrist.
Is this information correct?
All details come from the public NPPES registry. Providers can update their record at nppes.cms.hhs.gov; changes appear here after the next weekly update.
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