Grady M. Clark Jr., O.D.P.a.

Primary specialty

OptometristTaxonomy code 152W00000X

License

457 Issued in MS

Legal business name

GRADY M. CLARK JR., O.D.P.A.

Practice address

2112 N Frontage Rd
Meridian, MS 39301-6158

Phone

(601) 693-2020

Fax

(601) 693-2690

NPI assigned

Sep 8, 2014

Organization subpart

No

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

Authorized official

Name

Mrs. Wendy K Clark

Title

Office Administrator

Phone

(601) 693-2020

Specialties & licenses 1

Addresses

Other names 1

• Eyetech Eyecare Center Doing business as

Locations

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

{
    "created_epoch": "1410134400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1487548800000",
    "number": "1922409028",
    "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": {
        "organization_name": "GRADY M. CLARK JR., O.D.P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-09-08",
        "last_updated": "2017-02-20",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "WENDY",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "OFFICE ADMINISTRATOR",
        "authorized_official_telephone_number": "601-693-2020",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "MS",
            "license": "457",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Eyetech Eyecare Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Cameron Goss
• Andrew Gowdey, M.D
• Dorothy Gowdy
• Otis Gowdy Jr., M.D.
• Grace P Kelly MD
• Kimberly Marie Grady, DMD
• Jessica Graham, RNFA
• Joshua Thomas Graham, PHARMD
• Leah Moore Graham, MOT
• Leon J. Graham, M.D.

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2017; 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.