Healthcare Provider Details

I. General information

NPI: 1942326244
Provider Name (Legal Business Name): ARKANSAS VISION DEVELOPMENT CENTER PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 04/16/2025
Certification Date: 04/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1021 S WALDRON RD
FORT SMITH AR
72903-2549
US

IV. Provider business mailing address

1021 S WALDRON RD
FORT SMITH AR
72903-2549
US

V. Phone/Fax

Practice location:
  • Phone: 479-478-8860
  • Fax: 479-478-8890
Mailing address:
  • Phone: 479-478-8860
  • Fax: 479-478-8890

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License Number2554
License Number StateAR

VIII. Authorized Official

Name: MRS. WANDA VAUGHN
Title or Position: OPTOMETRIST
Credential: O.D
Phone: 479-478-8860