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General NPI Number Information
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NPI Number | 1033295639
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Entity Type | Organization
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Legal Business Name | CHARLES TODD, PA
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Dates
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Enumeration Date | 10/27/2006
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Last Update Date | 03/01/2010
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Provider Practice Location Address
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Address Line | 552 LOCUST ST
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City | CONWAY
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State | AR
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Zip | 72034-5325
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Country | US
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Telephone | 501-329-6859
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Fax | 501-329-6850
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Provider Business Mailing Address
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Address Line | 552 LOCUST ST
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City | CONWAY
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State | AR
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Zip | 72034-5325
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Country | US
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Telephone | 501-329-6859
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Fax | 501-329-6850
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Authorized Official
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Title or Position | OWNER
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Name | CHARLES TODD
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Credential | O.D.
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Telephone | 501-329-6859
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 2476
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License Number State | AR
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