Clark, Kevin Grafton
Clark, Kevin Grafton is an sole proprietor health care provider with primary practice located at 5310 Highway 25 Suite 5, Flowood MS 39232-6148. He recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as his primary health care specialty. Clark, Kevin Grafton can be contacted via phone (601) 919-0040.Contact Information
Primary practice address
5310 Highway 25 Suite 5
Flowood MS 39232-6148
Phone: (601) 919-0040
Fax: (601) 919-0083
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Eye and Vision Services Providers / Optometrist | 152W00000X | 498 | Mississippi |
Profile Details
| NPI number | 1912947144 |
|---|---|
| LBN Legal business name | Clark, Kevin Grafton |
| Credentials | O.D., P.A. |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Jun 7th, 2006 |
| Last updated | Jun 16th, 2014 - about 10 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1912947144 | NPPES |
| Mississippi | MEDICAID | 00087918 |
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