DR. GRADY MIMS CLARK JR. (NPI# 1831276278) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1831276278 |
| Entity Type | Individual |
| Full Name | DR. GRADY MIMS CLARK JR. |
| Credential | O.D. |
| Practice Address |
2112 N Frontage Rd Meridian MS 39301-6158 |
| Practice Telephone | 6016932020 |
| Practice Fax Number | 6016932690 |
| Mailing Telephone | 6016932020 |
| Mailing Fax Number | 6016932690 |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2018-09-11 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 152W00000X | Optometrist | 457 | MS | Eye and Vision Services Providers |
| Y | 152WC0802X |
Optometrist Specialization: Corneal and Contact Management |
457 | MS | Eye and Vision Services Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MS | 00087865 | 05 |
| Street Address |
2112 N FRONTAGE RD |
| City | MERIDIAN |
| State | MS |
| Zip Code | 39301-6158 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922409028 | Grady M. Clark Jr., O.d.p.a. | Optometrist | 2112 N Frontage Rd, Meridian, MS 39301-6158 | 2014-09-08 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407460439 | Kayla Lee Monsour | Pharmacist | 1415 24th Avenue, Meridian, MS 39301 | 2020-09-08 |
| 1306478359 | K&r Optical Solutions Corporation | Eyewear Supplier (Equipment, not the service) | 3126 8th St., Suite A, Meridian, MS 39301 | 2020-02-07 |
| 1912537317 | Courtney M Hollie | Counselor | 1054 Ms-19, Meridian, MS 39301 | 2020-01-24 |
| 1932636495 | Rcg Mississippi, Inc. | Clinic/Center | 1300 38th Ave E, Meridian, MS 39301 | 2017-05-16 |
| 1811428915 | Tierria Mcglothin | Nurse Practitioner | 1054 Highway 19 S, Meridian, MS 39301 | 2017-03-21 |
| 1154869303 | Lindsay Nemanich | Physical Therapist | 3716 Ms-39, Meridian, MS 39301 | 2017-02-08 |
| 1700323599 | Wal-mart Stores East Lp | Pharmacy | 3310-a Highway 39 North, Meridian, MS 39301 | 2017-01-31 |
| 1972977460 | Southeast Pharmacy LLC | Pharmacy | 2402 Long Creek Road, Meridian, MS 39301 | 2015-11-20 |
| 1235508342 | East Mississippi Oral & Facial Surgery, LLC | Clinic/Center | 1212 24th Avenue, Meridian, MS 39301 | 2015-09-18 |
| 1831580778 | Clarkdale Pharmacy and Gifts LLC | Pharmacy | 6935c Hwy 145, Meridian, MS 39301 | 2015-02-13 |
| Find all providers in zip 39301 | ||||
| Taxonomy Code | 152WC0802X |
| Grouping | Eye and Vision Services Providers |
| Classification | Optometrist |
| Specialization | Corneal and Contact Management |
| The professional activities performed by an Optometrist related to the fitting of contact lenses to an eye, ongoing evaluation of the cornea’s ability to sustain successful contact lens wear, and treatment of any external eye or corneal condition which can affect contact lens wear. |
| Notes: Source: American Optometric Association [1/1/2009: added definition, added source] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538337902 | Tri County Eye Clinic, Pllc | Optometrist | 15122 Dedeaux Rd, Gulfport, MS 39503-3120 | 2008-02-19 |
| 1396793188 | Hazlehurst Vision Clinic | Optometrist | 247 North Caldwell Dr., Suite B, Hazlehurst, MS 39083 | 2006-05-04 |
| 1528026309 | Moore Vision Inc | Optometrist | 1722 Veterans Blvd, Ste C2, Mccomb, MS 39648-2052 | 2006-05-02 |
| 1407825037 | Barnes Crossing Vision Center P. A. | Optometrist | 3929 N Gloster St, Tupelo, MS 38804-0915 | 2006-03-16 |
| 1073516456 | Christopher Cockrum White | Optometrist | 5341 Lakeland Dr, Flowood, MS 39232-6173 | 2005-05-31 |
| 1093859563 | Sidney Maurice Wilson | Optometrist | 6745 S Siwell Rd, Suite 106, Byram, MS 39272-8700 | 2007-02-17 |
| 1700834728 | James Stephen Moore | Optometrist | 1722 Veterans Blvd, Suite C-2, Mccomb, MS 39648-2000 | 2006-05-04 |
| 1700859881 | Tri County Eye Clinic, Pllc | Optometrist | 431 Bertucci Blvd, Biloxi, MS 39531-2255 | 2006-02-09 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.