IndividualActive
Chad Clark, O.D.
NPI 1205241577 · Optometrist · Boise, ID
Provider details
- NPI number
- 1205241577
- Entity type
- Individual
- Primary specialty
- OptometristEye and Vision Services Providers
- Credential
- O.D.
- Sex
- Male
- Sole proprietor
- Yes
- License
- ODP-100308 (ID)
Specialties & taxonomies
Eye and Vision Services Providers
Practice location
1205 S Five Mile Rd
Boise, ID 83709-1304
Phone: (208) 322-8381
Approximate (ZIP-level) locationGet directions
Mailing address
1205 S Five Mile Rd
Boise, ID 83709-1304
Registry dates
- Enumerated
- 2014-06-25
- Last updated
- 2022-11-14
- Certified
- 2022-11-14
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.