Graham Cloverleaf Optical Inc.

Primary specialty

OptometristTaxonomy code 152W00000X

License

AR2380 Issued in AR

Legal business name

GRAHAM CLOVERLEAF OPTICAL INC.

Practice address

113 N Plaza CT
Van Buren, AR 72956-2269

Phone

(479) 474-7878

Fax

(479) 471-1476

NPI assigned

Dec 10, 2008

Organization subpart

No

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

Authorized official

Name

Dr. Kelly L Graham, O.D.NPI 1447239629

Title

Owner/Optometrist

Phone

(479) 474-7878

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in AR

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kelly Leigh Graham, O.D.

  • Optometrist
  • Van Buren, AR
  • NPI 1447239629

  AR, Optometrist

  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1228867200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1715731200000",
    "number": "1760627376",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "113 N PLAZA CT",
            "city": "VAN BUREN",
            "state": "AR",
            "postal_code": "729562269",
            "telephone_number": "479-474-7878",
            "fax_number": "479-471-1476"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "113 N PLAZA CT",
            "city": "VAN BUREN",
            "state": "AR",
            "postal_code": "729562269",
            "telephone_number": "479-474-7878",
            "fax_number": "479-471-1476"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRAHAM CLOVERLEAF OPTICAL INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-12-10",
        "last_updated": "2024-05-15",
        "certification_date": "2024-05-15",
        "status": "A",
        "authorized_official_last_name": "GRAHAM",
        "authorized_official_first_name": "KELLY",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OWNER/OPTOMETRIST",
        "authorized_official_telephone_number": "479-474-7878",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "AR",
            "license": "AR2380",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "171400722",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Emma Claire Goodman
• Casey Beth Goodwin
• Kristina Anne Gordon, PTA
• William Gordon
• Destiny Rebekah Goss
• Kelly Leigh Graham, O.D.
• Kevin Franklin Graham, HHP.BC-HIS
• Kristy L Graham, D.C.
• Stephen C. Graves, M.D.
• Ashlee Nicole Greb

• All providers in Van Buren, AR
• Optometrist in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.