THOMAS EDWARD CLARK OD
NPI 1669096020
Optometrist in South Jordan, UT

Active since June 02, 2020PECOS EnrolledAccepts Medicare Assignment
3672 W SOUTH JORDAN PKWY STE 103, SOUTH JORDAN, UT 84009(801) 810-1060 Get Directions Write a Review

NPPES record last updated: June 2, 2020. Verified against the NPPES registry weekly; last sync: July 26, 2026.

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

NPI1669096020
Entity TypeIndividualMale
Primary Taxonomy152W00000X
Provider Legal NameTHOMAS EDWARD CLARKCredential: OD
Location Address3672 W SOUTH JORDAN PKWY STE 103South Jordan, UT 84009-7172
Mailing Address458 E 200 NPleasant Grove, UT 84062-2821 · (385) 439-7172
Sole ProprietorNo
Medical School CMSOtherGraduated 2020
Enumeration DateJune 2, 2020
NPPES CertifiedJune 2, 2020
NPI 1669096020 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 4

Primary SpecialtyOptometristEye and Vision Services Providers
Taxonomy Code152W00000X
License Licensed in UT · 11777686-9934
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.

Also ListedOptometrist · PediatricsTaxonomy 152WP0200X · License 11777686-9934 (UT)
Also ListedOptometrist · Sports VisionTaxonomy 152WS0006X · License 11777686-9934 (UT)
Also ListedOptometrist · Vision TherapyTaxonomy 152WV0400X · License 11777686-9934 (UT)
3672 W SOUTH JORDAN PKWY STE 103, South Jordan, UT 84009

Accepted Insurance

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

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.

PECOS PAC ID4385060037
PECOS Enrollment IDI20200812002801
Eligible to Order & Refer Part B Labs & Imaging Durable Medical Equipment Home Health Agency Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

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.

New Patient
$125.70 typical visit price
range $54.34 – $166.03
Typical copayment $31.42 (range $13.58 – $41.50)
Most-billed visit code 99204
Established Patient
$68.01 typical visit price
range $17.23 – $135.20
Typical copayment $17.00 (range $4.30 – $33.80)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

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.

What insurance does Thomas Clark accept?

Health plans from Blue Cross and Blue Shield of Montana, Blue Cross and Blue Shield of Oklahoma, Blue Cross and Blue Shield of Texas, Providence Health Plan and University of Utah Health Plans 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 with the weekly NPPES data releases published by CMS.