Healthcare Provider Details

I. General information

NPI: 1447253273
Provider Name (Legal Business Name): KILGORE VISION CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 01/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2943 HIGHWAY 62 W
MOUNTAIN HOME AR
72653-6535
US

IV. Provider business mailing address

PO BOX 444
MOUNTAIN HOME AR
72654-0444
US

V. Phone/Fax

Practice location:
  • Phone: 870-424-4900
  • Fax: 870-424-4979
Mailing address:
  • Phone: 870-424-4900
  • Fax: 870-424-4979

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: DR. KENNETH MERLE KILGORE
Title or Position: OWNER PRESIDENT
Credential: MD
Phone: 870-424-4900