Healthcare Provider Details

I. General information

NPI: 1669839486
Provider Name (Legal Business Name): CJMH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2016
Last Update Date: 01/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 NATHAN ST
MARKED TREE AR
72365-1448
US

IV. Provider business mailing address

800 PROFESSIONAL ACRES DR
JONESBORO AR
72401-4340
US

V. Phone/Fax

Practice location:
  • Phone: 870-358-2236
  • Fax: 870-358-4692
Mailing address:
  • Phone: 870-358-2236
  • Fax: 870-358-4692

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: BART C JONES
Title or Position: PRESIDENT
Credential: OD
Phone: 870-333-1087