Healthcare Provider Details

I. General information

NPI: 1922067115
Provider Name (Legal Business Name): DALE LYNN MORRIS O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2006
Last Update Date: 01/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 DILLARD ST
FORREST CITY AR
72335-3260
US

IV. Provider business mailing address

330 DILLARD ST
FORREST CITY AR
72335-3260
US

V. Phone/Fax

Practice location:
  • Phone: 870-633-1174
  • Fax: 870-633-3838
Mailing address:
  • Phone: 870-633-1174
  • Fax: 870-633-3838

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2137
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: