NPIMap

Organization Active NPI

Craig W. Cleveland, O.D., P.a.

  • Optometrist
  • Booneville, MS
National Provider Identifier
1487784518
Registry record updated Dec 27, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
532 Issued in MS
Legal business name
CRAIG W. CLEVELAND, O.D., P.A.
Practice address
202 N 2ND St
Booneville, MS 38829-2702
Phone
(662) 728-6191
Fax
(662) 728-9430
NPI assigned
Mar 7, 2007
Last updated
Dec 27, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 27, 2012

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

Authorized official

Name
Dr. Craig W Cleveland, O.D.NPI 1396859054
Title
President
Phone
(662) 728-6191

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 532 MS Primary

Addresses

Primary practice location

202 N 2ND St
Booneville, MS 38829-2702

Mailing address

202 N 2ND St
Booneville, MS 38829-2702
Phone (662) 728-6191

Other identifiers 2

IdentifierTypeStateIssuer
00880096MedicaidMS
06985007MedicaidMS

Other names 1

  • Family Optometry Other name

National Provider Directory

National Provider Directory

Locations

202 N 2nd St
Booneville, MS 38829
Phone (662) 728-6191

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1173225600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1356566400000",
    "number": "1487784518",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "202 N 2ND ST",
            "city": "BOONEVILLE",
            "state": "MS",
            "postal_code": "388292702",
            "telephone_number": "662-728-6191",
            "fax_number": "662-728-9430"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "202 N 2ND ST",
            "city": "BOONEVILLE",
            "state": "MS",
            "postal_code": "388292702",
            "telephone_number": "662-728-6191",
            "fax_number": "662-728-9430"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CRAIG W. CLEVELAND, O.D., P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-07",
        "last_updated": "2012-12-27",
        "status": "A",
        "authorized_official_last_name": "CLEVELAND",
        "authorized_official_first_name": "CRAIG",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "662-728-6191",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MS",
            "license": "532",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00880096",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "06985007",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Family Optometry",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Booneville, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 27, 2012; 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.