Gregory Clark, O.D., Inc.
Gregory Clark, O.D., Inc. is a healthcare organization registered as Optometrist in Coon Rapids, MN, holding Type 2 (organization) NPI 1801965504 since 2006. The authorized official on file is Gregory Clark, Owner.
✓ Active NPI ✓ Valid NPI checksum
| NPI | 1801965504 |
|---|---|
| Entity type | Organization (Type 2) |
| Legal business name | Gregory Clark, O.D., Inc. |
| Practice address | 12547 RIVERDALE BLVD NW, COSTCO OPTICAL DEPARTMENT, Coon Rapids, MN, 55448 |
| Phone | 7637127761 |
| Fax | 7637127787 |
| Enumeration date | 2006-11-07 |
| Last updated in NPPES | 2012-11-29 |
Authorized official
| Name | Gregory Clark |
|---|---|
| Title | Owner |
| Phone | 6127030298 |
Taxonomy & classification
| Taxonomy code | Specialty | Primary | License | State |
|---|---|---|---|---|
| 152W00000X | Optometrist | Primary | 2806 | MN |
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1634747-00 | Medicaid | MN | — |
Copy-ready billing details
Provider: Gregory Clark, O.D., Inc. NPI: 1801965504 Taxonomy: 152W00000X (Optometrist) Address: 12547 RIVERDALE BLVD NW, COSTCO OPTICAL DEPARTMENT, Coon Rapids, MN, 55448
Providers at this address
| NPI | Name | Type | Specialty | Location |
|---|---|---|---|---|
| 1568572188 | Costco Wholesale Corporation | Organization | Community/Retail Pharmacy | Coon Rapids, MN |
| 1467521153 | Gregory Clark | Individual | Optometrist | Coon Rapids, MN |
| 1770866865 | Spring Romer | Individual | Pharmacist | Coon Rapids, MN |
| 1326439167 | Costco Wholesale Corporation | Organization | Eyewear Supplier | Coon Rapids, MN |
| 1962897819 | Costco Wholesale Corporation | Organization | Hearing Aid Equipment | Coon Rapids, MN |
Verify this record
Cross-check NPI 1801965504 against the authoritative CMS record: view Gregory Clark, O.D., Inc. on the official NPPES registry .
What is an NPI number?
A National Provider Identifier (NPI) is a unique 10-digit number that CMS assigns to every U.S. healthcare provider and organization under HIPAA. Type 1 NPIs identify individual providers; Type 2 NPIs identify organizations. The NPI appears on insurance claims, prescriptions, and credentialing paperwork, and never changes — even if the provider moves or changes specialty. Read the full guide or validate an NPI number.
Frequently asked questions
What is the NPI number for Gregory Clark, O.D., Inc.?
Who is the authorized official for Gregory Clark, O.D., Inc.?
Source: CMS NPPES (public data). Snapshot 2026-07-11. Provider record last updated 2012-11-29.