Healthcare Provider Details

I. General information

NPI: 1316534506
Provider Name (Legal Business Name): DR. PENNY'S EYE CARE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2020
Last Update Date: 04/05/2021
Certification Date: 04/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5501 S OLIVE ST
PINE BLUFF AR
71603-7607
US

IV. Provider business mailing address

163 GLENN HILL DR
ALEXANDER AR
72002-9405
US

V. Phone/Fax

Practice location:
  • Phone: 870-536-2200
  • Fax: 870-534-7362
Mailing address:
  • Phone: 501-940-9796
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: DR. PENNY FRESHOUR
Title or Position: OPTOMETRIST/OWNER
Credential: OD
Phone: 501-940-9796