DR. Jackie Harold Clark SR., O.D.
NPI #1790769065 in Broken Arrow, Oklahoma
Provider Information
- NPI Number
- 1790769065
- Entity Type
- Individual
- Name
- DR. Jackie Harold Clark SR., O.D.
- Gender
- Not Specified
- Sole Proprietor
- Yes
- Primary Specialty
- Optometrist
- Credential
- O.D.
- Enumeration Date
- Dec 1, 2005
- Last Updated
- Jun 10, 2011
Practice Location
- Address
- 1805 N 13TH ST
- City
- Broken Arrow
- State
- Oklahoma
- ZIP Code
- 74012-8256
- Phone
- (918) 872-1833
Specialties & Taxonomy Codes
| Specialty |
|---|
| Optometrist |
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