Healthcare Provider Details

I. General information

NPI: 1780742973
Provider Name (Legal Business Name): FAULKNER EYE CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 01/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1805 STATE HIGHWAY 77
MARION AR
72364-9011
US

IV. Provider business mailing address

1805 STATE HIGHWAY 77 SUITE 16
MARION AR
72364-9011
US

V. Phone/Fax

Practice location:
  • Phone: 870-739-2020
  • Fax: 870-739-2939
Mailing address:
  • Phone: 870-739-2020
  • Fax: 870-739-2939

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2472
License Number StateAR

VIII. Authorized Official

Name: DR. JULIE STUTZMAN FAULKNER
Title or Position: OPTOMETRIC PHYSICIAN
Credential: OD
Phone: 870-739-2020