Samantha Clark, OD in Plymouth, IN - Medicare Optometry Provider

Samantha Clark, OD is a medicare enrolled "Optometrist" provider in Plymouth, Indiana. She went to Illinois College Of Optometry At Chicago and graduated in 2019 and has 7 years of diverse experience with area of expertise as Optometry. She is a member of the group practice Aeg Indiana Professional Pc and her current practice location is 2878 Miller Dr, Plymouth, Indiana. You can reach out to her office (for appointments etc.) via phone at (574) 935-3937.

Samantha Clark is licensed to practice in Indiana (license number 18004186A) and she also participates in the medicare program. She accepts medicare assignments (which means she accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance) and her NPI Number is 1033763016.

Contact Information

	Samantha Clark, OD
	2878 Miller Dr, Plymouth, IN 46563-8094
	(574) 935-3937
	(574) 936-4942

Map and Direction

Healthcare Provider's Profile

Full Name	Samantha Clark
Gender	Female
Speciality	Optometry
Experience	7 Years
Location	2878 Miller Dr, Plymouth, Indiana
Accepts Medicare Assignments	Yes. She accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance.

Medical Education and Training:

Samantha Clark attended and graduated from Illinois College Of Optometry At Chicago in 2019

NPI Data:

NPI Number: 1033763016
Provider Enumeration Date: 07/29/2019
Last Update Date: 02/28/2023

Medicare PECOS Information:

PECOS PAC ID: 3678800729
Enrollment ID: I20190812003048

Medical Identifiers

Medical identifiers for Samantha Clark such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1033763016	NPI	-	NPPES
18004186A	Other	IN	OPTOMETRY LICENSE

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
152W00000X	Optometrist	18004186A (Indiana)	Primary

Group Practice Association

Group Practice Name	Group PECOS PAC ID	No. of Members
Aeg Indiana Professional Pc	2365826179	23

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Samantha Clark allows following entities to bill medicare on her behalf.

Provider Name	Plymouth Eye Clinic Pc
Provider Type	Part B Supplier - Clinic/group Practice
Provider Identifiers	NPI Number: 1942368733 PECOS PAC ID: 4981695665 Enrollment ID: O20040520001476

Provider Name	Aeg Indiana Professional Pc
Provider Type	Part B Supplier - Clinic/group Practice
Provider Identifiers	NPI Number: 1043944127 PECOS PAC ID: 2365826179 Enrollment ID: O20220829000590

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Samantha Clark is enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing Address	Practice Location Address
Samantha Clark, OD 111 E 4th St Ste 440, Alton, IL 62002-6206 Ph: () -	Samantha Clark, OD 2878 Miller Dr, Plymouth, IN 46563-8094 Ph: (574) 935-3937

Reviews and Comments

Optometrist in Plymouth, IN

Allison Garmon, O.d., Llc Optometrist Medicare: Medicare Enrolled Practice Location: 109 N Walnut St, Plymouth, IN 46563 Phone: 574-936-2272 Fax: 574-936-1283
Kelsey K Bell, O.D. Optometrist Medicare: Accepting Medicare Assignments Practice Location: 2878 Miller Dr, Plymouth, IN 46563 Phone: 574-935-3937 Fax: 574-936-4942
Brian S Baird, OD PC Optometrist Medicare: Medicare Enrolled Practice Location: 12921 Plymouth Goshen Trl, Plymouth, IN 46563 Phone: 574-936-3212 Fax: 574-936-3481
Full Sail Partners, Llc Optometrist Medicare: Not Enrolled in Medicare Practice Location: 215 N Michigan St, Plymouth, IN 46563 Phone: 574-936-8144
Michiana Eye Center Llc Optometrist Medicare: Not Enrolled in Medicare Practice Location: 320 Meadow Ln, Plymouth, IN 46563 Phone: 574-935-4480 Fax: 574-941-2040
Daniel Joseph Zych, O.D. Optometrist Medicare: Medicare Enrolled Practice Location: 2505 N Oak Dr, Plymouth, IN 46563 Phone: 574-935-4224

Samantha Clark, OD - Medicare Optometrist in Plymouth, IN