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General NPI Number Information
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NPI Number | 1063683761
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Entity Type | Organization
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Legal Business Name | ARKANSAS EYECARE SPECIALIST
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Dates
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Enumeration Date | 03/20/2008
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Last Update Date | 06/25/2008
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Provider Practice Location Address
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Address Line | 2402 HARRISON ST
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City | BATESVILLE
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State | AR
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Zip | 72501-7421
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Country | US
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Telephone | 870-793-4681
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Fax | 870-793-7745
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Provider Business Mailing Address
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Address Line | 2402 HARRISON ST
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City | BATESVILLE
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State | AR
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Zip | 72501-7421
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Country | US
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Telephone | 870-793-4681
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Fax | 870-793-7745
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Authorized Official
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Title or Position | OWNER
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Name | DR. SAM D. COOKE
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Credential | O.D.
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Telephone | 870-793-4681
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State | AR
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