Healthcare Provider Details

I. General information

NPI: 1235503558
Provider Name (Legal Business Name): HOANG EYE CARE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/24/2015
Last Update Date: 03/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9053 HIGHWAY 107
SHERWOOD AR
72120-2933
US

IV. Provider business mailing address

308 MONTICELLO W
BRYANT AR
72022-8351
US

V. Phone/Fax

Practice location:
  • Phone: 501-412-8519
  • Fax:
Mailing address:
  • Phone: 501-412-8519
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2683
License Number StateAR

VIII. Authorized Official

Name: KIMMY HOANG
Title or Position: OPTOMETRIST
Credential: OD
Phone: 870-723-5573