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General NPI Number Information
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NPI Number | 1154638153
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Entity Type | Organization
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Legal Business Name | TRI-STATE OPTICAL CENTER, PLLC
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Dates
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Enumeration Date | 09/12/2010
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Last Update Date | 04/18/2025
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Provider Practice Location Address
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Address Line | 1401 W WALNUT ST
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City | ROGERS
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State | AR
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Zip | 72756-3317
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Country | US
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Telephone | 479-636-2012
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Fax |
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Provider Business Mailing Address
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Address Line | 1714 W WALNUT ST
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City | ROGERS
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State | AR
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Zip | 72756-3324
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Country | US
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Telephone | 479-636-2012
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Fax |
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Authorized Official
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Title or Position | OD
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Name | MRS. KATHERINE A LANDIS
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Credential | OD
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Telephone | 479-636-2012
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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 | 2594
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License Number State | AR
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