Healthcare Provider Details

I. General information

NPI: 1942157284
Provider Name (Legal Business Name): CAMERON CROCKETT OD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/16/2026
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 N COLLEGE AVE
FAYETTEVILLE AR
72703-1944
US

IV. Provider business mailing address

265 E DUNBAR LN APT 205
FAYETTEVILLE AR
72703-3280
US

V. Phone/Fax

Practice location:
  • Phone: 479-443-4301
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3337
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: