Provider Demographics
NPI:1447365176
Name:CLARKE, CHRISTOPHER ANDREW (OD)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:ANDREW
Last Name:CLARKE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:DR
Other - First Name:ANDREW
Other - Middle Name:
Other - Last Name:CLARKE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:217 STONEWALL ST
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38112-5113
Mailing Address - Country:US
Mailing Address - Phone:901-276-3538
Mailing Address - Fax:
Practice Address - Street 1:2760 NORTH GERMATOWN PKWY
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38133
Practice Address - Country:US
Practice Address - Phone:901-276-3538
Practice Address - Fax:901-722-3538
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1178152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3597110Medicare ID - Type Unspecified