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General NPI Number Information
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NPI Number | 1104961911
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Entity Type | Organization
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Legal Business Name | EYE CARE OPTICAL
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Dates
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Enumeration Date | 02/20/2007
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Last Update Date | 01/23/2020
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Provider Practice Location Address
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Address Line | 9800 BAPTIST HEALTH DR STE 301
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City | LITTLE ROCK
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State | AR
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Zip | 72205-6230
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Country | US
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Telephone | 501-225-4507
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Fax | 501-225-9299
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Provider Business Mailing Address
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Address Line | 9800 BAPTIST HEALTH DRIVE SUITE 301
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City | LITTLE ROCK
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State | AR
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Zip | 72205
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Country | US
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Telephone | 501-225-4507
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Fax | 501-225-9299
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Authorized Official
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Title or Position | PART OWNER
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Name | KENNAN ARTIMUS DOAN
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Credential | O.D.
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Telephone | 501-225-4507
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number |
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License Number State | AR
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