Healthcare Provider Details

I. General information

NPI: 1497627400
Provider Name (Legal Business Name): IIII OPTICAL - DOG TOWN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2025
Last Update Date: 09/19/2025
Certification Date: 09/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

312 W PERSHING BLVD
NORTH LITTLE ROCK AR
72114-2224
US

IV. Provider business mailing address

10700 N RODNEY PARHAM RD STE C2
LITTLE ROCK AR
72212-4159
US

V. Phone/Fax

Practice location:
  • Phone: 501-830-2020
  • Fax:
Mailing address:
  • Phone: 501-830-2020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: BYRON N WILKES
Title or Position: OWNER
Credential: MD
Phone: 501-830-2020