Provider Demographics
NPI:1215917703
Name:CLARK-SCHRYNEMAKERS, JOANNE M (OD)
Entity type:Individual
Prefix:
First Name:JOANNE
Middle Name:M
Last Name:CLARK-SCHRYNEMAKERS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:JOANNE
Other - Middle Name:MARIE
Other - Last Name:CLARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2110 NORTHERN BLVD
Mailing Address - Street 2:SUITE 208
Mailing Address - City:MANHASSET
Mailing Address - State:NY
Mailing Address - Zip Code:11030-3502
Mailing Address - Country:US
Mailing Address - Phone:516-627-5113
Mailing Address - Fax:516-365-2817
Practice Address - Street 1:2110 NORTHERN BLVD
Practice Address - Street 2:SUITE 208
Practice Address - City:MANHASSET
Practice Address - State:NY
Practice Address - Zip Code:11030-3502
Practice Address - Country:US
Practice Address - Phone:516-627-5113
Practice Address - Fax:516-365-2817
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-19
Last Update Date:2025-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1097152W00000X
FLTPOP91152W00000X
MAOPT3933152W00000X
NY4601294152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
C66921Medicare ID - Type Unspecified
U81806Medicare UPIN