Healthcare Provider Details

I. General information

NPI: 1902383631
Provider Name (Legal Business Name): ARKANSAS FAMILY EYECARE OF MALVERN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2018
Last Update Date: 06/24/2020
Certification Date: 06/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1023 S MAIN ST
MALVERN AR
72104-5222
US

IV. Provider business mailing address

11225 HURON LN STE 200A
LITTLE ROCK AR
72211-1861
US

V. Phone/Fax

Practice location:
  • Phone: 501-332-6262
  • Fax: 501-337-0373
Mailing address:
  • Phone: 501-225-9944
  • Fax: 501-225-9933

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: TASKER RODMAN III
Title or Position: PARTNER
Credential: OD
Phone: 501-225-9944