Healthcare Provider Details

I. General information

NPI: 1982662375
Provider Name (Legal Business Name): CLIFFORD M TURNER II OD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 05/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 WESTPORT DR STE D
CABOT AR
72023
US

IV. Provider business mailing address

200 WESTPORT DR STE D
CABOT AR
72023-3609
US

V. Phone/Fax

Practice location:
  • Phone: 501-941-7555
  • Fax:
Mailing address:
  • Phone: 501-941-7555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2323
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number2323
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: