Healthcare Provider Details

I. General information

NPI: 1730139692
Provider Name (Legal Business Name): JIM DUDLEY OD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: JIM DUDLEY OD

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 02/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 COUNTY 301
EUREKA SPRINGS AR
72632-9192
US

IV. Provider business mailing address

112 COUNTY 301
EUREKA SPRINGS AR
72632-9192
US

V. Phone/Fax

Practice location:
  • Phone: 479-445-0317
  • Fax: 479-253-9479
Mailing address:
  • Phone: 479-445-0317
  • Fax: 479-253-9479

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2261
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: