Individual
DR. GRADY MIMS CLARK JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
2112 N FRONTAGE RD, MERIDIAN, MS 39301-6158
(601) 693-2020
(601) 693-2690
Mailing address
2112 N FRONTAGE RD, MERIDIAN, MS 39301-6158
(601) 693-2020
(601) 693-2690
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
457
MS
152WC0802X
Corneal and Contact Management Optometrist
Primary
457
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00087865
—
MS
Enumeration date
11/01/2006
Last updated
09/11/2018
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