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Contact Information

GRADY M CLARK JR, OD
2112 N FRONTAGE RD
MERIDIAN, MS39301-6158
 Phone: 601-693-2020
 Fax: 601-693-2690
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Corneal and Contact Management

152WC0802X 41 Optometry
 

Optometrist

152W00000X 41 Optometry
Indicates primary specialty

NPI Profile & details for GRADY M CLARK JR · (Male)

NPI Number 1831276278
Status Active
Credentials OD (Doctor of Optometry)
Entity Individual
Enumeration date 11/01/2006
Last updated 09/11/2018 - About 8 years ago
Sole proprietor 1 Yes
Identifiers
  • MS License # 457
  • MS Medicaid 00087865
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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