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DR. KIM M CLARK O.D.
NPI 1215091095
Optometrist in Portland, OR

Active since December 19, 2006
12000 SE 82ND AVENUE, #2012, PORTLAND, OR 97266(503) 652-6001(503) 652-6012 Get Directions Write a Review

NPPES record last updated: May 11, 2009. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Dr. Kim M Clark O.d. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. KIM M CLARK O.D. (NPI 1215091095) is an individual optometrist in Portland, Oregon, licensed in Oregon (2911ATI) and active in the NPI registry since December 2006.

NPPES Registry Identity

NPI1215091095
Entity TypeIndividualMale
Primary Taxonomy152W00000X
Provider Legal NameDR. KIM M CLARKCredential: O.D.
Location Address12000 SE 82ND AVENUE, #2012Portland, OR 97266-7721
Mailing Address2318 Nw Edgewood PlPortland, OR 97229-7618 · (503) 292-4033 · Fax (503) 292-2474
Phone(503) 652-6001
Fax(503) 652-6012
Sole ProprietorNo
Enumeration DateDecember 19, 2006
Last NPPES UpdateMay 11, 2009
✔ NPI 1215091095 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyOptometristEye and Vision Services Providers
Taxonomy Code152W00000X
License✔ Licensed in OR · 2911ATI
Definition
Doctors of optometry (ODs) are the primary health care professionals for the eye. Optometrists examine, diagnose, treat, and manage diseases, injuries, and disorders of the visual system, the eye, and associated structures as well as identify related systemic conditions affecting the eye. An optometrist has completed pre-professional undergraduate education in a college or university and four years of professional education at a college of optometry, leading to the doctor of optometry (O.D.) degree. Some optometrists complete an optional residency in a specific area of practice. Optometrists are eye health care professionals state-licensed to diagnose and treat diseases and disorders of the eye and visual system.
12000 SE 82ND AVENUE, Portland, OR 97266
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Other Names 1

Professional Name (2)Kim M Clark Od

Other Identifiers 1

Medicare ID-Type Unspecified000009413UT

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. KIM M CLARK & ASSOCIATES LLC
Optometrist
12000 SE 82ND AVENUE, #2012
PORTLAND, OR 97266
Multnomah County (503) 652-6001

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Kim Clark's NPI number?

The NPI number for Kim Clark is 1215091095. It was assigned to this individual provider in the NPPES registry on December 19, 2006. The provider is also known as Kim M Clark Od.

Where is Kim Clark located?

Kim Clark practices at 12000 SE 82nd Avenue #2012, Portland, OR 97266. The listed phone number is (503) 652-6001.

What is Kim Clark's specialty?

The primary specialty registered for this NPI is Optometrist with taxonomy code 152W00000X.

When was this NPI record last updated?

The NPPES record for Kim Clark was last updated on May 11, 2009. NPI Profile syncs with the weekly NPPES data releases published by CMS.