Healthcare Provider Details

I. General information

NPI: 1275116832
Provider Name (Legal Business Name): BRIGHT EYES VISION CARE, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2021
Last Update Date: 05/03/2021
Certification Date: 05/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 S 52ND ST STE 102
ROGERS AR
72758-8640
US

IV. Provider business mailing address

900 S 52ND ST STE 102
ROGERS AR
72758-8640
US

V. Phone/Fax

Practice location:
  • Phone: 479-657-6006
  • Fax: 479-657-6006
Mailing address:
  • Phone: 479-657-6006
  • Fax: 479-657-6006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: DR. JACOB DUFOUR
Title or Position: PRESIDENT
Credential: OD
Phone: 479-685-6875