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

Last updated

May 15, 2024By the provider in NPPES

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

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, and the practitioner matching its NPPES authorized official.

• Kelly Leigh Graham, O.D.

  • Optometrist
  • Van Buren, AR
  • NPI 1447239629
  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": [],
    "endpoints": [],
    "other_names": []
}

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

• Optometrist in Van Buren, AR
• Providers in Van Buren, AR by specialty
• 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.