EDWARD C CLARK (NPI# 1124028311) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1124028311 |
| Entity Type | Individual |
| Full Name | EDWARD C CLARK |
| Credential | M.D. |
| Practice Address |
11355 Pembrooke Sq Suite 107 Waldorf MD 20603-4805 |
| Practice Telephone | 3018437711 |
| Practice Fax Number | 3019329195 |
| Mailing Telephone | 3018437711 |
| Mailing Fax Number | 3019329195 |
| Enumeration Date | 2005-07-28 |
| Last Update Date | 2016-08-08 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207W00000X | Ophthalmology | D0017492 | MD | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MD | 228502900 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043570732 | Edward Clark | Counselor | 4015 Nine Mcfarland Dr, Suite #175, Alpharetta, GA 30004-8493 | 2012-05-29 |
| 1093028870 | Edward Derby Clark I | Counselor | 1355 Pebblewood Dr, Sacramento, CA 95833-1612 | 2010-07-21 |
| 1053474080 | Edward Joseph Clark IIi | Radiology | 1705 S. Tarboro St, Wilson, NC 27893 | 2006-12-19 |
| 1730294232 | Edward Deallen Clark | Obstetrics & Gynecology | 1600 W College St Ste Ll10, Grapevine, TX 76051-3598 | 2006-08-21 |
| 1205843604 | Edward Mark Clark | Dentist | 5211 Yellowstone Rd, Ste # 1, Cheyenne, WY 82009-4761 | 2006-08-01 |
| 1528074523 | Edward Lee Clark | Dentist | 2727 Sw 17th Pl, Redmond, OR 97756-1297 | 2006-07-31 |
| 1013917814 | Edward C Clark | Internal Medicine | 311 W 24th St, Suite 402, Erie, PA 16502-2665 | 2005-07-22 |
| 1063072429 | Edward Clark | Technician | 1310 6th St Nw, Washington, DC 20001-3495 | 2019-06-18 |
| 1710490800 | Edward E Clark Jr. | Registered Nurse | 10 Penfield Ave, Akron, OH 44310-2912 | 2017-11-10 |
| 1033638424 | Edward Clark | Licensed Practical Nurse | 6600 E Ben White Blvd, Austin, TX 78741-7537 | 2017-09-17 |
| Street Address |
11355 PEMBROOKE SQ SUITE 107 |
| City | WALDORF |
| State | MD |
| Zip Code | 20603-4805 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902006299 | Jones Pembrooke Opticians, LLC | Technician/Technologist | 11355 Pembrooke Sq, Suite 106, Waldorf, MD 20603-4805 | 2007-07-24 |
| 1497702203 | Charles Care Pharmacy LLC | Pharmacy | 11355 Pembrooke Sq, Ste 109, Waldorf, MD 20603-4805 | 2006-05-27 |
| 1609876846 | Edward C. Clark,m.d.,p.a. | Ophthalmology | 11355 Pembrooke Sq, Suite 107, Waldorf, MD 20603-4805 | 2005-07-29 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437764214 | Kelly Weaver | Nurse Practitioner | 11315 Pembroke Square, 110, Waldorf, MD 20603 | 2020-09-09 |
| 1962937839 | Alexis Nicole Smith | Specialist/Technologist | 6115 Tapir Pl, Waldorf, MD 20603 | 2017-04-27 |
| 1235585472 | Msb Counseling Services, Inc | Counselor | 1282 Smallwood Drive W, Suite 460, Waldorf, MD 20603 | 2016-05-06 |
| 1619390325 | Tara Wood | Nurse Practitioner | 3070crain Highway, Waldorf, MD 20603 | 2014-01-31 |
| 1649603424 | Lauren Ashley White | Speech-Language Pathologist | 10810 Winchester Street Apt127, Waldorf, MD 20603 | 2013-08-15 |
| 1477810067 | Johnathan Vital | Clinical Neuropsychologist | 2413 Altenburg Ct, Waldorf, MD 20603 | 2012-04-19 |
| 1831480615 | Tara Marie Adams | Physical Therapist | 11340 Pembrooke Sq Ste 211, Waldorf, MD 20603 | 2011-04-27 |
| 1891007662 | Tanuja Katta | Pharmacist | 3385 Crain High Way, Rite Aid 11197, Waldorf, MD 20603 | 2010-07-09 |
| 1962725697 | Rhonda Bumpers-bland | Occupational Therapist | 2945 Fern Hill Place, Waldorf, MD 20603 | 2010-03-09 |
| 1265672901 | Shannon L Hamm | Counselor | 6126 Gray Wolf Court, Waldorf, MD 20603 | 2009-02-20 |
| Find all providers in zip 20603 | ||||
| Taxonomy Code | 207W00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Ophthalmology |
| An ophthalmologist has the knowledge and professional skills needed to provide comprehensive eye and vision care. Ophthalmologists are medically trained to diagnose, monitor and medically or surgically treat all ocular and visual disorders. This includes problems affecting the eye and its component structures, the eyelids, the orbit and the visual pathways. In so doing, an ophthalmologist prescribes vision services, including glasses and contact lenses. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Ophthalmology, 2007. http://www.abop.org/. American Osteopathic Board of Ophthalmology and Otolaryngology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Ophthalmology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Ophthalmology and Otolaryngology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962643395 | Consulting Ophthalmologists LLC | Ophthalmology | 3460 Old Washington Rd Ste 302, Waldorf, MD 20602-3245 | 2009-03-14 |
| 1114981149 | John Y Choi | Ophthalmology | 3460 Old Washington Rd Ste 101, Waldorf, MD 20602-3241 | 2006-04-14 |
| 1093715310 | Omar Farooq Ahmad | Ophthalmology | 3460 Old Washington Rd, Ste 302, Waldorf, MD 20602-3240 | 2005-07-28 |
| 1538163514 | Frederick J Sauerburger | Ophthalmology | 11345 Pembrooke Sq, Ste 105, Waldorf, MD 20603-4804 | 2005-06-08 |
| 1689017709 | Olivia Dryjski | Ophthalmology | 3460 Old Washington Rd Ste 302, Waldorf, MD 20602 | 2013-04-08 |
| 1356375513 | Omar F. Ahmad, M.d., P.C. | Ophthalmology | 3460 Old Washington Rd, Suite 302, Waldorf, MD 20602-3240 | 2006-07-11 |
| 1750314399 | Aruoriwo M Oboh-weilke | Ophthalmology | 3460 Old Washington Rd, Suite 302, Waldorf, MD 20602-3240 | 2006-07-08 |
| 1609876846 | Edward C. Clark,m.d.,p.a. | Ophthalmology | 11355 Pembrooke Sq, Suite 107, Waldorf, MD 20603-4805 | 2005-07-29 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568086304 | Envue Eye & Laser Center LLC | Ophthalmology | 251 Harbor Blvd, Oxon Hill, MD 20745 | 2020-06-06 |
| 1003437641 | Goel Vision Columbia | Ophthalmology | 8850 Columbia 100 Pkwy Ste 101, Columbia, MD 21045-2375 | 2020-05-06 |
| 1568083103 | Columbia Parkway Surgery Center LLC | Ophthalmology | 8850 Columbia 100 Pkwy Ste 102, Columbia, MD 21045-2375 | 2020-05-06 |
| 1508402769 | Rachel Bishop | Ophthalmology | 31 Center Dr Bldg 31, Suite 6a11, Bethesda, MD 20892-0001 | 2019-11-22 |
| 1114562626 | Laservue, LLC | Ophthalmology | 5530 Wisconsin Ave Ste 1209, Chevy Chase, MD 20815-4301 | 2019-11-08 |
| 1144786104 | Samir Jabbour | Ophthalmology | 600 North Wolfe Street, Johns Hopkins Hospital Wilmer E, Baltimore, MD 21287 | 2019-02-14 |
| 1114408689 | Precision Eye Care | Ophthalmology | 1645 Liberty Rd Ste 101, Eldersburg, MD 21784-6537 | 2018-08-23 |
| 1558848747 | Advanced Glaucoma Eyecare | Ophthalmology | 8101 Sandy Spring Rd Ste 105, Laurel, MD 20707-3596 | 2018-07-20 |
| 1245736750 | Stuart Lessans | Ophthalmology | 6112 Rosemont Circle, Rockville, MD 20852 | 2018-04-03 |
| 1801302104 | Katzen Medical Associates, PC | Ophthalmology | 901 Dulaney Valley Rd Ste 200, Towson, MD 21204-0603 | 2017-12-21 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.