Healthcare Provider Details

I. General information

NPI: 1598757148
Provider Name (Legal Business Name): JAMES L. PRICE JR. OD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2005
Last Update Date: 10/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

408 W MCCLOY ST
MONTICELLO AR
71655
US

IV. Provider business mailing address

408 W MCCLOY ST
MONTICELLO AR
71655-4325
US

V. Phone/Fax

Practice location:
  • Phone: 870-367-8511
  • Fax: 870-367-3215
Mailing address:
  • Phone: 870-367-8511
  • Fax: 870-367-3215

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberAR2158
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: