Healthcare Provider Details

I. General information

NPI: 1093225633
Provider Name (Legal Business Name): SUCCESS VISION EXPRESS OF CONWAY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2017
Last Update Date: 10/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 S AMITY RD STE B
CONWAY AR
72032-8106
US

IV. Provider business mailing address

5312 W 41ST ST
TULSA OK
74107-6110
US

V. Phone/Fax

Practice location:
  • Phone: 918-895-1700
  • Fax:
Mailing address:
  • Phone: 918-895-1700
  • Fax: 877-464-4002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: VERONICA DANSBY
Title or Position: INSURANCE SPECIALIST
Credential:
Phone: 918-895-1700