Healthcare Provider Details

I. General information

NPI: 1700057361
Provider Name (Legal Business Name): NORTHWEST ARKANSAS RETINA ASSOCIATES, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2008
Last Update Date: 11/27/2023
Certification Date: 01/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5501 WILLOW CREEK DR STE 203B
SPRINGDALE AR
72762-8708
US

IV. Provider business mailing address

601 W MAPLE AVE SUITE 205A
SPRINGDALE AR
72764-5335
US

V. Phone/Fax

Practice location:
  • Phone: 479-419-9393
  • Fax: 479-419-9513
Mailing address:
  • Phone: 479-419-9393
  • Fax: 479-419-9513

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SERRHEL G ADAMS JR.
Title or Position: PRESIDENT, VITREORETINAL SURGEON
Credential: M.D., PH.D.
Phone: 479-419-9393