Healthcare Provider Details

I. General information

NPI: 1467878520
Provider Name (Legal Business Name): MASON CHARLES SEELINGER O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2014
Last Update Date: 11/09/2020
Certification Date: 11/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3805 W 28TH AVE
PINE BLUFF AR
71603-4774
US

IV. Provider business mailing address

3805 W 28TH AVE
PINE BLUFF AR
71603-4774
US

V. Phone/Fax

Practice location:
  • Phone: 870-536-4100
  • Fax: 870-534-3982
Mailing address:
  • Phone: 870-536-4100
  • Fax: 870-534-3982

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberAR2691
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: