Graham Cloverleaf Optical INC.
Optometrist in Van Buren, AR. Organization (NPI-2).
NPI number1760627376
StatusActive
Last updated in NPPESMay 15, 2024
Details
- NPI
- 1760627376
- Entity type
- Organization (NPI-2)
- Legal business name
- Graham Cloverleaf Optical INC.
- Organization subpart
- No
- Enumeration date
- Dec 10, 2008
- Certification date
- May 15, 2024
- Last updated
- May 15, 2024
Medicare and OIG
- Medicare enrolled (PECOS)
- Yes · PART B SUPPLIER - CLINIC/GROUP PRACTICE
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 152W00000X | Optometrist | AR2380 | AR | Yes |
Practice location
113 N Plaza CtVan Buren, AR 72956-2269
Phone 479-474-7878 · Fax 479-471-1476
Mailing address
113 N Plaza CtVan Buren, AR 72956-2269
Phone 479-474-7878 · Fax 479-471-1476
Authorized official
Kelly L Graham
Owner/Optometrist
4794747878
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