GREGORY CLARK, O.D., INC.
NPI 1801965504
Optometrist in Coon Rapids, MN

Q: What is Gregory Clark, O.D., Inc.'s NPI number?

The NPI number for Gregory Clark, O.D., Inc. is 1801965504. It was assigned to this organization in the NPPES registry on November 7, 2006.

Q: What is Gregory Clark, O.D., Inc.'s specialty?

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

Active since November 07, 2006

12547 RIVERDALE BLVD NW, COSTCO OPTICAL DEPARTMENT, COON RAPIDS, MN 55448(763) 712-7761(763) 712-7787 Get Directions Write a Review

NPPES record last updated: November 29, 2012. Verified against the NPPES registry weekly; last sync: October 25, 2026.

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About Gregory Clark, O.d., Inc. NPPES

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

GREGORY CLARK, O.D., INC. (NPI 1801965504) is a healthcare organization registered as an optometrist in Coon Rapids, Minnesota and active in the NPI registry since November 2006. The organization lists Gregory Alexander Clark, Owner, as its authorized official.

NPPES Registry Identity

NPI1801965504

Entity TypeOrganization

Primary Taxonomy152W00000X

Legal Business NameGREGORY CLARK, O.D., INC.

Location Address12547 RIVERDALE BLVD NW, COSTCO OPTICAL DEPARTMENTCoon Rapids, MN 55448-6708

Mailing Address16160 22nd Pl NPlymouth, MN 55447-2382 · (612) 703-0298

Phone(763) 712-7761

Fax(763) 712-7787

Organization SubpartNo

Authorized OfficialGregory Alexander ClarkOwner · (612) 703-0298

Enumeration DateNovember 7, 2006

Last NPPES UpdateNovember 29, 2012

✔ NPI 1801965504 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 MN · 2806

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.

12547 RIVERDALE BLVD NW, Coon Rapids, MN 55448

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Other Identifiers 3

Medicare UPINU86742MN

Medicaid1634747-00MN

Medicare PIN410001679MN

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Blue Cross and Blue Shield of Louisiana, Blue Cross Blue Shield of Wyoming.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Gregory Clark, O.d., Inc. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 4 clinicians reassign Medicare billing to Gregory Clark, O.D., Inc., which bills Medicare for the services they deliver. Of these, 1 practice at this address and 2 within 10 miles. They are listed nearest first.

Clinicians, nearest first (4)

Gregory Clark, O.D.

Optometry

NPI 1467521153

12547 RIVERDALE BLVD NW COSTCO OPTICAL DEPARTMENT
Coon Rapids, MN 55448

(763) 712-7761

✔ PECOS✔ Accepts MedicareSame address

Christina Nguyen

Optometry

NPI 1407478969

1851 BUNKER LAKE BLVD NW
Andover, MN 55304

(763) 354-5717

✔ PECOS2.3 mi

Jason Stensos, OD

Optometry

NPI 1205844966

9721 LYNDALE AVE SO OXBORO EYE CLINIC
Bloomington, MN 55420

(952) 884-8338

✔ PECOS✔ Accepts Medicare26 mi

Christina Tran, OD

Optometry

NPI 1083222459

15121 E MISSISSIPPI AVE
Aurora, CO 80012

(303) 802-1022

✔ PECOS✔ Accepts Medicare697 mi

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

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 Gregory Clark, O.D., Inc.'s NPI number?

The NPI number for Gregory Clark, O.D., Inc. is 1801965504. It was assigned to this organization in the NPPES registry on November 7, 2006.

Where is Gregory Clark, O.D., Inc. located?

Gregory Clark, O.D., Inc. is located at 12547 Riverdale Blvd NW Costco Optical Department, Coon Rapids, MN 55448. The listed phone number is (763) 712-7761.

What is Gregory Clark, O.D., Inc.'s specialty?

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

Is Gregory Clark, O.D., Inc. enrolled in Medicare?

Yes. Gregory Clark, O.D., Inc. is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Gregory Clark, O.D., Inc.?

According to the CMS Revalidation Reassignment List (October 2026 release), 4 clinicians, all in Optometry, reassign their Medicare billing to Gregory Clark, O.D., Inc.. A 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 the clinician's services. Of these, 1 practice at this address and 2 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

What insurance does Gregory Clark, O.D., Inc. accept?

Health plans from Blue Cross Blue Shield of Wyoming and Blue Cross and Blue Shield of Louisiana list Gregory Clark, O.D., Inc. 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 Gregory Clark, O.D., Inc. was last updated on November 29, 2012. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 13 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.