Healthcare Provider Details

I. General information

NPI: 1023897253
Provider Name (Legal Business Name): REBECCA JANE SIMMONS BROWN OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: REBECCA JANE SIMMONS

II. Dates (important events)

Enumeration Date: 09/26/2023
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

594 E MILLSAP RD
FAYETTEVILLE AR
72703-4096
US

IV. Provider business mailing address

594 E MILLSAP RD
FAYETTEVILLE AR
72703-4096
US

V. Phone/Fax

Practice location:
  • Phone: 479-442-2020
  • Fax: 479-521-3988
Mailing address:
  • Phone: 479-442-2020
  • Fax: 479-521-3988

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2880
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: