Philip Randle Graham, O.D.
Individual provider Active NPI Optometrist · Pontotoc, MS
NPI 1164572848 · NPPES record last updated Nov 10, 2008
Key facts
- NPI
- 1164572848
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- 491 (MS)
- Practice address
- 14 E Marion St
Pontotoc, MS 38863-2813 - Phone
- (662) 489-4741
- Fax
- (662) 489-2940
- NPI assigned
- Jan 12, 2007
- Sex
- Male
- Sole proprietor
- Yes
Medicare Care Compare profile
- Specialty
- Optometry
- Education
- Southern College of Optometry, 1980
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
14 E Marion St
Pontotoc, MS 38863-2813
Phone (662) 489-4741
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Cataract surgery | 51 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MS
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20120425000381 | MS | Practitioner - Optometry | 0042320319 | Practice locations: Pontotoc, MS |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 491 | MS | Yes |
Addresses
Primary practice location
14 E Marion St
Pontotoc, MS 38863-2813
Mailing address
PO Box 120
Pontotoc, MS 38863-0120
Phone (662) 489-4741
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00087908 | Medicaid | MS |
Other providers in Pontotoc, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 10, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.