THOMAS EDWARD CLARK OD
NPI 1669096020
Optometrist in South Jordan, UT
About Thomas Edward Clark Od NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
THOMAS EDWARD CLARK OD (NPI 1669096020) is an individual optometrist in South Jordan, Utah, licensed in Utah (11777686-9934) and active in the NPI registry since June 2020. He is enrolled in Medicare PECOS and is a graduate of Other (2020).
NPPES Registry Identity
Specialties & Licenses 4
Accepted Insurance
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare and accepts Medicare assignment
Thomas Edward Clark Od is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.
Medicare Billing Reassignments
2Medicare enrollment records show Thomas Clark reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.
South Jordan, UT 84009
- Reassigned Medicare billing, Utah enrollment
- 2 clinicians in this Medicare group
American Fork, UT 84003
- Reassigned Medicare billing, Utah enrollment
- 4 clinicians in this Medicare group
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Physician Visit Costs CMS claims · ZIP area
Typical Medicare office-visit costs in the 84009 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.
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 Thomas Clark's NPI number?
The NPI number for Thomas Clark is 1669096020. It was assigned to this individual provider in the NPPES registry on June 2, 2020.
Where is Thomas Clark located?
Thomas Clark practices at 3672 W South Jordan Pkwy Ste 103, South Jordan, UT 84009. The listed phone number is (801) 810-1060.
What is Thomas Clark's specialty?
The primary specialty registered for this NPI is Optometrist with taxonomy code 152W00000X.
Is Thomas Clark enrolled in Medicare?
Yes. Thomas Clark is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.
Which organizations bill Medicare for Thomas Clark's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Thomas Clark reassigns Medicare benefits to 2 organizations: Utah Vision Development Center, LLC (South Jordan, UT) and Kenneth E Hooton, O.D. (American Fork, UT). Each reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Thomas Clark's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
What insurance does Thomas Clark accept?
Health plans from Anthem Blue Cross and Blue Shield, Blue Cross and Blue Shield of Montana, Blue Cross and Blue Shield of Oklahoma, Blue Cross and Blue Shield of Texas and Providence Health Plan and 1 other insurer list Thomas Clark as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.
When was this NPI record last updated?
The NPPES record for Thomas Clark was last updated on June 2, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Thomas Edward Clark, OD · NPI 1669096020
Optometrist provider in South Jordan, Utah. Individual provider, active in the CMS NPPES registry since June 2, 2020.
## Identity
- **NPI:** 1669096020 (Entity type: Individual)
- **Enumerated:** June 2, 2020
- **Primary specialty:** Optometrist · taxonomy 152W00000X
- **State license:** 11777686-9934 (Utah)
- **Sole proprietor:** No
## Practice location
- **Address:** 3672 W SOUTH JORDAN PKWY STE 103, South Jordan, UT 84009-7172
- **Phone:** (801) 810-1060
## Medicare
- **Medicare:** Enrolled (PECOS); accepts Medicare assignment
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health
- **Bills Medicare through:** 2 organizations under Medicare reassignment (form CMS-855R): Utah Vision Development Center, LLC (NPI 1104123801, South Jordan, UT); Kenneth E Hooton, O.D. (NPI 1134390255, American Fork, UT) · CMS Revalidation Reassignment List, October 2026 release
- **Medical school:** Other, class of 2020
## Record status
- **NPPES last updated:** June 2, 2020
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Source: [NPI Profile](https://npiprofile.com/npi/1669096020) · Data from the CMS NPPES public registry.