Healthcare Provider Details

I. General information

NPI: 1063681039
Provider Name (Legal Business Name): DR. JAMES L. PRICE, JR.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2008
Last Update Date: 09/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 HIGHWAY 425 S
MONTICELLO AR
71655-4611
US

IV. Provider business mailing address

301 HIGHWAY 425 S
MONTICELLO AR
71655-4611
US

V. Phone/Fax

Practice location:
  • Phone: 870-367-8534
  • Fax: 870-367-0264
Mailing address:
  • Phone: 870-367-8534
  • Fax: 870-367-0264

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number2158
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberAR2158
License Number StateAR

VIII. Authorized Official

Name: DR. JAMES L PRICE JR.
Title or Position: OWNER
Credential: O.D.
Phone: 870-367-8534