Healthcare Provider Details

I. General information

NPI: 1962605659
Provider Name (Legal Business Name): ROBERT FITZHUGH, OD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2007
Last Update Date: 06/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 THOMAS ST
STAMPS AR
71860
US

IV. Provider business mailing address

P.O.BOX 38
STAMPS AR
71860
US

V. Phone/Fax

Practice location:
  • Phone: 870-533-2327
  • Fax:
Mailing address:
  • Phone: 870-533-2327
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2263
License Number StateAR

VIII. Authorized Official

Name: DR. ROBERT C FITZHUGH
Title or Position: OWNER
Credential: OD
Phone: 870-533-2327