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General NPI Number Information
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NPI Number | 1215747449
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Entity Type | Organization
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Legal Business Name | OZARK EYE, PLLC
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Dates
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Enumeration Date | 01/09/2025
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Last Update Date | 01/09/2025
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Provider Practice Location Address
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Address Line | 455 SLACK ST
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City | PEA RIDGE
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State | AR
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Zip | 72751
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Country | US
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Telephone | 479-208-6175
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Fax | 479-208-6173
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Provider Business Mailing Address
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Address Line | 1118 NW G ST
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City | BENTONVILLE
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State | AR
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Zip | 72712-4235
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Country | US
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Telephone | 479-857-3838
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Fax |
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Authorized Official
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Title or Position | OWNER/OPTOMETRIST
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Name | DR. TRENT DAIBER
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Credential |
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Telephone | 479-208-6175
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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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