Grady Mims Clark Jr., O.D.

Primary specialty

Corneal and Contact Management OptometristTaxonomy code 152WC0802X

License

457 Issued in MS

Practice address

2112 N Frontage Rd
Meridian, MS 39301-6158

Phone

(601) 693-2020

Fax

(601) 693-2690

NPI assigned

Nov 1, 2006

Last updated

Sep 11, 2018By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1536624000000",
    "number": "1831276278",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2112 N FRONTAGE RD",
            "city": "MERIDIAN",
            "state": "MS",
            "postal_code": "393016158",
            "telephone_number": "601-693-2020",
            "fax_number": "601-693-2690"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2112 N FRONTAGE RD",
            "city": "MERIDIAN",
            "state": "MS",
            "postal_code": "393016158",
            "telephone_number": "601-693-2020",
            "fax_number": "601-693-2690"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "GRADY",
        "middle_name": "MIMS",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-01",
        "last_updated": "2018-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MS",
            "license": "457",
            "primary": false
        },
        {
            "code": "152WC0802X",
            "taxonomy_group": "",
            "desc": "Optometrist, Corneal and Contact Management",
            "state": "MS",
            "license": "457",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00087865",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ciclops Telepathology LLC (The Skin Cancer Clinic)
• Erica Clanahan
• Amber Clanton
• Claripath Counseling and Consulting LLC
• Clark Chiropractic Clinic PA
• James Eugene Clark, D.D.S.
• Kimberly Deyonne Clark, CMHT
• Robert E Clark, M.D.
• Ronald H Clark, DC
• Sandra Denice Clark, ED.S

• Corneal and Contact Management Optometrist in Meridian, MS
• Providers in Meridian, MS by specialty
• Corneal and Contact Management Optometrist in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2018; 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.