NPIMap

Individual provider Active NPI

Clemit W Liles III, O.D.

  • Optometrist
  • Fort Smith, AR
National Provider Identifier
1003044355
Registry record updated Nov 28, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
2626 Issued in AR
Practice address
2425 S Zero St
Fort Smith, AR 72901-8663
Phone
(479) 763-1230
Fax
(479) 777-4614
NPI assigned
Jun 25, 2009
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 28, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 2626 AR Primary

Addresses

Primary practice location

2425 S Zero St
Fort Smith, AR 72901-8663

Mailing address

17569 Fishtrap Rd Ste 30
Prosper, TX 75078-5122
Phone (469) 715-0775

Other names 1

  • Dr. Clemit W Liles III Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090821000560 AR Practitioner - Optometry 5597819748 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Southern College of Optometry, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Med Southwest PLLC 234 clinicians

Practice addresses (Care Compare)

208 Morrow St S
Mena, AR 71953-2510
Phone (479) 394-4215

Procedures performed for Medicare patients

ProcedureNumber of procedures
Cataract surgery1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2626ARMDPediatric Physical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Med Southwest, PLLC Optometrist Current Accepting new patients
Eyes on Prosper, PLLC Optometrist CurrentSince Nov 13, 2022 Accepting new patients
Med Southwest, PLLC Optometrist CurrentSince Apr 1, 2019 Accepting new patients
Silver Spring Optometry, LLC Optometrist Past Accepting new patients
C Wallace Liles Jr OD PA Optometrist Past Accepting new patients

Locations

208 Morrow St S
Mena, AR 71953
Phone (479) 394-4215

114 E 49th St
Texarkana, AR 71854
Phone (870) 774-2020

8614 Westwood Center Dr
Fl 9
Vienna, VA 22182

Organizations & group practices 20

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

View all 20

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1245888000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701129600000",
    "number": "1003044355",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17569 FISHTRAP RD STE 30",
            "city": "PROSPER",
            "state": "TX",
            "postal_code": "750785122",
            "telephone_number": "469-715-0775"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2425 S ZERO ST",
            "city": "FORT SMITH",
            "state": "AR",
            "postal_code": "729018663",
            "telephone_number": "479-763-1230",
            "fax_number": "479-777-4614"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LILES",
        "first_name": "CLEMIT",
        "middle_name": "W",
        "name_prefix": "Dr.",
        "name_suffix": "III",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-06-25",
        "last_updated": "2023-11-28",
        "certification_date": "2023-11-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "AR",
            "license": "2626",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CLEMIT",
            "last_name": "LILES",
            "middle_name": "W",
            "prefix": "DR.",
            "suffix": "III",
            "credential": "OD",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Fort Smith, AR

Sources for this page

Verify at the official NPI Registry.