Healthcare Provider Details

I. General information

NPI: 1215753272
Provider Name (Legal Business Name): IIII OPTICAL - THE BLUFF LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/25/2024
Last Update Date: 11/25/2024
Certification Date: 11/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3805 W 28TH AVE
PINE BLUFF AR
71603-4774
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: 870-536-4100
  • 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: CYNTHIA JONES
Title or Position: OPTICAL MANAGER
Credential:
Phone: 501-254-9999