Healthcare Provider Details

I. General information

NPI: 1346301736
Provider Name (Legal Business Name): ROBERT KYLE HURST O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1412 SE 14TH ST
BENTONVILLE AR
72712-6812
US

IV. Provider business mailing address

1412 SE 14TH ST
BENTONVILLE AR
72712-6812
US

V. Phone/Fax

Practice location:
  • Phone: 479-271-9700
  • Fax: 479-271-9771
Mailing address:
  • Phone: 479-271-9700
  • Fax: 479-271-9771

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2448
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: