Clark, Grady Mims

Clark, Grady Mims is an sole proprietor health care provider with primary practice located at 2112 N Frontage Rd , Meridian MS 39301-6158. He recently has 2 registered licenses in different health care specialties including Eye and Vision Services Providers / Optometrist, Eye and Vision Services Providers / Corneal and Contact Management. Eye and Vision Services Providers / Corneal and Contact Management is his primary health care specialty. Clark, Grady Mims can be contacted via phone (601) 693-2020.

Contact Information

Primary practice address
2112 N Frontage Rd Meridian MS 39301-6158
Phone: (601) 693-2020
Fax: (601) 693-2690
Website:
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Health care specialties

SpecialtyCodeLicense #State
Eye and Vision Services Providers / Optometrist 152W00000X 457 Mississippi
Eye and Vision Services Providers / Corneal and Contact Management 152WC0802X 457 Mississippi

Profile Details

NPI number 1831276278
LBN Legal business name Clark, Grady Mims
Credentials Doctor of Optometry (OD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Nov 1st, 2006
Last updated Sep 11th, 2018 - about 8 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1831276278 NPPES
Mississippi MEDICAID 00087865

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