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General NPI Number Information
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NPI Number | 1144014739
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Entity Type | Organization
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Legal Business Name | ELISSA BOSTIAN OD PLLC
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Dates
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Enumeration Date | 04/08/2025
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Last Update Date | 04/08/2025
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Provider Practice Location Address
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Address Line | 1517 GENE GEORGE BLVD
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City | SPRINGDALE
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State | AR
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Zip | 72762-0716
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Country | US
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Telephone | 479-365-7166
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Fax |
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Provider Business Mailing Address
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Address Line | 17070 HARMON RD
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City | FAYETTEVILLE
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State | AR
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Zip | 72704-8620
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Country | US
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Telephone | 479-841-6059
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. ELISSA BOSTIAN
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Credential | OD
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Telephone | 479-365-7166
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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 |
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License Number State |
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