Healthcare Provider Details

I. General information

NPI: 1538563895
Provider Name (Legal Business Name): VISION THERAPY CENTER OF JONESBORO, P.L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2014
Last Update Date: 10/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3705 E JOHNSON AVE SUITE B
JONESBORO AR
72401-1858
US

IV. Provider business mailing address

3705 E JOHNSON AVE SUITE B
JONESBORO AR
72401-1858
US

V. Phone/Fax

Practice location:
  • Phone: 870-336-0387
  • Fax: 870-336-2455
Mailing address:
  • Phone: 870-336-0387
  • Fax: 870-336-2455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License Number2591
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License Number2628
License Number StateAR

VIII. Authorized Official

Name: DR. MEGAN MOLL
Title or Position: OWNER/OPTOMETRIST
Credential: O.D
Phone: 870-336-0387