Healthcare Provider Details

I. General information

NPI: 1366731002
Provider Name (Legal Business Name): MORGAN VISION CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2011
Last Update Date: 04/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 W MAIN ST
CABOT AR
72023-2944
US

IV. Provider business mailing address

215 W MAIN ST
CABOT AR
72023-2944
US

V. Phone/Fax

Practice location:
  • Phone: 501-843-7511
  • Fax: 501-941-2020
Mailing address:
  • Phone: 501-843-7511
  • Fax: 501-941-2020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2168
License Number StateAR

VIII. Authorized Official

Name: DR. TASKER N RODMAN II
Title or Position: OPTOMETRIC PHYSICIAN
Credential: O.D.
Phone: 501-843-7511