Healthcare Provider Details

I. General information

NPI: 1043355506
Provider Name (Legal Business Name): BRIAN W. BUELL O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4083 N SHILOH DR SUITE ONE
FAYETTEVILLE AR
72703-5300
US

IV. Provider business mailing address

4083 N SHILOH DR SUITE ONE
FAYETTEVILLE AR
72703-5300
US

V. Phone/Fax

Practice location:
  • Phone: 479-521-7774
  • Fax: 479-521-4928
Mailing address:
  • Phone: 479-521-7774
  • Fax: 479-521-4928

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberAR2213
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: