Healthcare Provider Details

I. General information

NPI: 1558774588
Provider Name (Legal Business Name): MARCUS CHASE LAW O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2014
Last Update Date: 04/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3004 E KIEHL AVE
SHERWOOD AR
72120-3228
US

IV. Provider business mailing address

3004 E KIEHL AVE
SHERWOOD AR
72120-3228
US

V. Phone/Fax

Practice location:
  • Phone: 501-835-7800
  • Fax: 501-835-5060
Mailing address:
  • Phone: 501-835-7800
  • Fax: 501-835-5060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2816
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2720
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: