Provider Demographics
NPI:1295494961
Name:ROBERT A CLARK MD MEDICAL CORPORATION
Entity type:Organization
Organization Name:ROBERT A CLARK MD MEDICAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:ALEXANDER
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-426-3925
Mailing Address - Street 1:955 DEEP VALLEY DR #2950
Mailing Address - Street 2:
Mailing Address - City:PALOS VERDES PENINSULA
Mailing Address - State:CA
Mailing Address - Zip Code:90274-3058
Mailing Address - Country:US
Mailing Address - Phone:310-707-8113
Mailing Address - Fax:
Practice Address - Street 1:4401 ATLANTIC AVE STE 410
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-2263
Practice Address - Country:US
Practice Address - Phone:562-459-3363
Practice Address - Fax:562-459-3364
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-10
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty