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Contact Information

KEVIN G CLARK, O.D., P.A.
5310 HIGHWAY 25
SUITE 5
FLOWOOD, MS39232-6148
 Phone: 601-919-0040
 Fax: 601-919-0083
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Optometrist

152W00000X 41 Optometry
Indicates primary specialty

NPI Profile & details for KEVIN G CLARK · (Male)

NPI # 1912947144
Status Active
Credentials O.D., P.A.
Entity Individual
Enumeration date 06/07/2006
Last updated 06/16/2014 - About 12 years ago
Sole proprietor 1 Yes
Identifiers
  • MS License # 498
  • MS Medicaid 00087918
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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