Healthcare Provider Details

I. General information

NPI: 1699956888
Provider Name (Legal Business Name): LANDIS EYE CARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2007
Last Update Date: 10/16/2020
Certification Date: 10/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2110 W WALNUT ST SUITE 4
ROGERS AR
72756-3297
US

IV. Provider business mailing address

2110 W WALNUT ST SUITE 4
ROGERS AR
72756-3297
US

V. Phone/Fax

Practice location:
  • Phone: 479-621-8391
  • Fax: 479-621-0962
Mailing address:
  • Phone: 479-621-8391
  • Fax: 479-621-0962

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2595
License Number StateAR

VIII. Authorized Official

Name: MRS. KATHERINE LANDIS
Title or Position: OPTOMETRIST
Credential: OD
Phone: 479-621-8391