Healthcare Provider Details

I. General information

NPI: 1770753253
Provider Name (Legal Business Name): BILL F. MORGAN, O.D.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2008
Last Update Date: 04/30/2008
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:
Mailing address:
  • Phone: 501-843-7511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2235
License Number StateAR

VIII. Authorized Official

Name: BILL F MORGAN
Title or Position: OWNER
Credential: OD
Phone: 501-843-7511