Kevin Grafton Clark, O.D., P.A.

Primary specialty

OptometristTaxonomy code 152W00000X

License

498 Issued in MS

Practice address

5310 Highway 25
Suite 5
Flowood, MS 39232-6148

Phone

(601) 919-0040

Fax

(601) 919-0083

NPI assigned

Jun 7, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

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.

• Jackson Eye Institute PLLC

  • Ophthalmology Physician
  • Jackson, MS
  • NPI 1467555250
  NPD (past)
• The Eye Clinic PA

  • Eyewear Supplier
  • Gulfport, MS
  • NPI 1427002864

  Optometrist

  NPD (past)
• Sunil Gupta MD LLC

  • Ophthalmology Physician
  • Pensacola, FL
  • NPI 1588610075
  NPD (past)

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

{
    "created_epoch": "1149638400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1402876800000",
    "number": "1912947144",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5310 HIGHWAY 25",
            "address_2": "SUITE 5",
            "city": "FLOWOOD",
            "state": "MS",
            "postal_code": "392326148",
            "telephone_number": "601-919-0040",
            "fax_number": "601-919-0083"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5310 HIGHWAY 25",
            "address_2": "SUITE 5",
            "city": "FLOWOOD",
            "state": "MS",
            "postal_code": "392326148",
            "telephone_number": "601-919-0040",
            "fax_number": "601-919-0083"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "KEVIN",
        "middle_name": "GRAFTON",
        "credential": "O.D., P.A.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-06-07",
        "last_updated": "2014-06-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MS",
            "license": "498",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00087918",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Laura House Christopher, M.D.
• Steven Cialone, PT, DPT
• Claire Logan, DDS, PLLC
• Klaye Clardy, NP
• Kathryn Clark, PHARM.D.
• Lacey Green Clark
• Lindsey W Clark, PHARMD
• Marcy S Clarke, NNP
• Tiffany Clarke, M.S., CCC-SLP
• Pamela Claypool, OT

• Optometrist in Flowood, MS
• Providers in Flowood, MS by specialty
• Optometrist in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2014; 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.