Healthcare Provider Details

I. General information

NPI: 1649221730
Provider Name (Legal Business Name): SALINE OPTICAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2006
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 MEDICAL PARK DR SUITE300
BENTON AR
72015-3728
US

IV. Provider business mailing address

3 MEDICAL PARK DR SUITE300
BENTON AR
72015-3728
US

V. Phone/Fax

Practice location:
  • Phone: 501-778-1113
  • Fax: 501-778-5391
Mailing address:
  • Phone: 501-778-1113
  • Fax: 501-778-5391

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: MRS. ANN HALL
Title or Position: OFFICE MANAGER
Credential:
Phone: 501-778-1113