NPIMap

Organization Active NPI

Mendenhall Optometric Eye Clinic, P.a.

Doing business as Mendenhall Eye Clinic

  • Optometrist
  • Mendenhall, MS
National Provider Identifier
1184742843
Registry record updated Apr 20, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
423 Issued in MS
Legal business name
MENDENHALL OPTOMETRIC EYE CLINIC, P.A.
Doing business as
Mendenhall Eye Clinic
Practice address
1021 East St
Mendenhall, MS 39114-3107
Phone
(601) 847-1232
Fax
(601) 847-1376
NPI assigned
Mar 27, 2007
Last updated
Apr 20, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 20, 2008

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

Authorized official

Name
Paul Willard Clark, O.D.
Title
President
Phone
(601) 847-1232

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 423 MS Primary

Addresses

Primary practice location

1021 East St
Mendenhall, MS 39114-3107

Mailing address

P. O. Box 577
Mendenhall, MS 39114-3107
Phone (601) 847-1232

Other identifiers 2

IdentifierTypeStateIssuer
00087015MedicaidMS
C03245OtherMSGROUP SUPPLIER CODE

Other names 1

  • Mendenhall Eye Clinic Doing business as

National Provider Directory

National Provider Directory

Locations

1021 East St
Mendenhall, MS 39114
Phone (601) 847-1232

NPI Registry JSON

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

{
    "created_epoch": "1174953600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208649600000",
    "number": "1184742843",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P. O. BOX 577",
            "city": "MENDENHALL",
            "state": "MS",
            "postal_code": "391143107",
            "telephone_number": "601-847-1232",
            "fax_number": "601-847-1376"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1021 EAST ST",
            "city": "MENDENHALL",
            "state": "MS",
            "postal_code": "391143107",
            "telephone_number": "601-847-1232",
            "fax_number": "601-847-1376"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MENDENHALL OPTOMETRIC EYE CLINIC, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-27",
        "last_updated": "2008-04-20",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "PAUL",
        "authorized_official_middle_name": "WILLARD",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "601-847-1232",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MS",
            "license": "423",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00087015",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP SUPPLIER CODE",
            "identifier": "C03245",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mendenhall Eye Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mendenhall, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.