Healthcare Provider Details

I. General information

NPI: 1710321955
Provider Name (Legal Business Name): KIMMY HOANG O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2013
Last Update Date: 08/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3929 MCCAIN BLVD
NORTH LITTLE ROCK AR
72116
US

IV. Provider business mailing address

308 MONTICELLO WEST
BRYANT AR
72022
US

V. Phone/Fax

Practice location:
  • Phone: 501-412-8519
  • Fax: 501-712-1414
Mailing address:
  • Phone: 870-723-5573
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2683
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: