Healthcare Provider Details

I. General information

NPI: 1952532681
Provider Name (Legal Business Name): HOT SPRINGS VISIONSOURCE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2009
Last Update Date: 10/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 SECTION LINE
HOT SPRINGS AR
71913
US

IV. Provider business mailing address

305 SECTION LINE
HOT SPRINGS AR
71913
US

V. Phone/Fax

Practice location:
  • Phone: 501-525-2222
  • Fax: 501-525-8650
Mailing address:
  • Phone: 501-525-2222
  • Fax: 501-525-8650

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2308
License Number StateAR

VIII. Authorized Official

Name: DALE BURROUGHS
Title or Position: OWNER
Credential: O.D.
Phone: 501-525-2222