Healthcare Provider Details

I. General information

NPI: 1356317473
Provider Name (Legal Business Name): BOOZMAN-HOF REGIONAL EYE CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3737 W. WALNUT
ROGERS AR
72757
US

IV. Provider business mailing address

25 CUNNINGHAM CORNER
BELLA VISTA AR
72714
US

V. Phone/Fax

Practice location:
  • Phone: 479-246-1700
  • Fax: 479-631-2629
Mailing address:
  • Phone: 479-246-1700
  • Fax: 479-631-2629

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number StateAR

VIII. Authorized Official

Name: MR. KEITH L FAUGHT
Title or Position: CLINIC ADMINISTRATOR
Credential:
Phone: 479-246-1700