DR. JACKIE HAROLD CLARK SR. O.D.
NPI 1790769065
Optometrist in Broken Arrow, OK

Q: What is Jackie Clark's NPI number?

The NPI number for Jackie Clark is 1790769065. It was assigned to this individual provider in the NPPES registry on December 1, 2005.

Q: What is Jackie Clark's specialty?

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

Q: When was this NPI record last updated?

The NPPES record for Jackie Clark was last updated on June 10, 2011. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 15 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.

Active since December 01, 2005

1805 N 13TH ST, BROKEN ARROW, OK 74012(918) 872-1833 Get Directions Write a Review

NPPES record last updated: June 10, 2011. Verified against the NPPES registry weekly; last sync: August 09, 2026.

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About Dr. Jackie Harold Clark Sr. O.d. NPPES

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

DR. JACKIE HAROLD CLARK SR. O.D. (NPI 1790769065) is an individual optometrist in Broken Arrow, Oklahoma, licensed in Oklahoma (1129) and active in the NPI registry since December 2005.

NPPES Registry Identity

NPI1790769065

Entity TypeIndividualMale

Primary Taxonomy152W00000X

Provider Legal NameDR. JACKIE HAROLD CLARK SR.Credential: O.D.

Location Address1805 N 13TH STBroken Arrow, OK 74012-8256

Mailing Address1805 N 13th StBroken Arrow, OK 74012-8256 · (918) 872-1833

Phone(918) 872-1833

Sole ProprietorYes

Enumeration DateDecember 1, 2005

Last NPPES UpdateJune 10, 2011

✔ NPI 1790769065 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 OK · 1129

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.

1805 N 13TH ST, Broken Arrow, OK 74012

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Other Identifiers 1

Medicaid100761100AOK

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 Jackie Clark's NPI number?

The NPI number for Jackie Clark is 1790769065. It was assigned to this individual provider in the NPPES registry on December 1, 2005.

Where is Jackie Clark located?

Jackie Clark practices at 1805 N 13th St, Broken Arrow, OK 74012. The listed phone number is (918) 872-1833.

What is Jackie 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 Jackie Clark was last updated on June 10, 2011. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 15 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.