Healthcare Provider Details

I. General information

NPI: 1679208276
Provider Name (Legal Business Name): JAMES WILLIAM HARDGRAVES OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2022
Last Update Date: 11/22/2022
Certification Date: 11/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2004 S PLEASANT ST
SPRINGDALE AR
72764-6204
US

IV. Provider business mailing address

4010 E CANVAS RD
FAYETTEVILLE AR
72701-4791
US

V. Phone/Fax

Practice location:
  • Phone: 479-263-0436
  • Fax:
Mailing address:
  • Phone: 479-263-0436
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2855
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: