James Flowers Humber IV, OD

Individual provider Active NPI Optometrist · Clarksdale, MS

NPI 1396808259 · NPPES record last updated Nov 17, 2011

Key facts

NPI
1396808259
Entity type
Individual (NPI type 1)
Primary specialty
Optometrist 152W00000X
License
633 (MS)
Practice address
636 Friars Point Rd
Clarksdale, MS 38614-9111
Phone
(662) 627-2020
Fax
(662) 627-7063
NPI assigned
Dec 19, 2006
Sex
Male
Sole proprietor
Yes

Organizations & group practices 1

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.

Medicare Care Compare profile

Specialty
Optometry
Education
Southern College of Medicine and Surgery, 1998
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

636 Friars Point Rd
Clarksdale, MS 38614-9111
Phone (662) 627-2020

Procedures performed for Medicare patients

ProcedureNumber of procedures
Cataract surgery30

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 IDStateProvider typePAC IDDetails
I20120130000150 MS Practitioner - Optometry 1355452681 Reassigns benefits to 1 organization

National Provider Directory

Medicare enrollment (NPD)
Yes

Practice roles

OrganizationSpecialtyStatusNew patients
Clarksdale Vision Center PA Optometrist Current
since Jul 22, 1998
Accepting new patients

Locations

636 Friars Point Rd
Clarksdale, MS 38614
Phone (662) 627-2020

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 633 MS Yes

Addresses

Primary practice location

636 Friars Point Rd
Clarksdale, MS 38614-9111

Mailing address

636 Friars Point Rd
Clarksdale, MS 38614-9111
Phone (662) 627-2020

Other identifiers

IdentifierTypeStateIssuer
00880128MedicaidMS

Other providers in Clarksdale, MS

All providers in Clarksdale, MS · Optometrist in Mississippi

Sources for this page

Verify at the official NPI Registry.