Cleveland Eye Clinic PA
Organization Active NPI Optometrist · Cleveland, MS
NPI 1962571380 · NPPES record last updated Mar 18, 2008
Key facts
- NPI
- 1962571380
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Optometrist 152W00000X
- License
- 546 (MS)
- Legal business name
- CLEVELAND EYE CLINIC PA
- Practice address
- 136 North Street
Cleveland, MS 38732 - Phone
- (662) 846-6641
- Fax
- (662) 846-6644
- NPI assigned
- Nov 7, 2006
- Organization subpart
- No
Authorized official
- Name
- Dr. Emmett Donald Smith
- Title
- President
- Phone
- (662) 846-6641
Practitioners 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MS
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20100429000532 | MS | Part B Supplier - Clinic/Group Practice | 7517094113 |
Receives reassigned benefits from 1 practitioner Practice locations: Cleveland, MS |
National Provider Directory
Locations
136 North St
Cleveland, MS 38732
Phone (662) 846-6641
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist |
152W00000X | 546 | MS | Yes |
Addresses
Primary practice location
136 North Street
Cleveland, MS 38732
Mailing address
PO Box 1108
Cleveland, MS 38732
Phone (662) 846-6641
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 09957099 | Medicaid | MS |
Other providers in Cleveland, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 18, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.