Healthcare Provider Details

I. General information

NPI: 1306807839
Provider Name (Legal Business Name): PAUL J. MISISCHIA D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2006
Last Update Date: 12/21/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3805 WEST 28TH AVE.
PINE BLUFF AR
71603
US

IV. Provider business mailing address

3805 WEST 28TH AVE.
PINE BLUFF AR
71603
US

V. Phone/Fax

Practice location:
  • Phone: 870-536-4100
  • Fax: 870-536-9020
Mailing address:
  • Phone: 870-536-4100
  • Fax: 870-536-9020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberOS004106-L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: