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General NPI Number Information
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NPI Number | 1285271163
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Entity Type | Organization
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Legal Business Name | AOA OPTICAL,LLC
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Dates
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Enumeration Date | 12/10/2019
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Last Update Date | 12/10/2019
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Provider Practice Location Address
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Address Line | 5 SAINT VINCENT CIR STE 200
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City | LITTLE ROCK
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State | AR
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Zip | 72205-5416
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Country | US
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Telephone | 501-661-1123
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Fax | 501-661-0046
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Provider Business Mailing Address
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Address Line | 5 SAINT VINCENT CIR STE 200
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City | LITTLE ROCK
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State | AR
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Zip | 72205-5416
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Country | US
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Telephone | 501-661-1123
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Fax | 501-661-0046
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Authorized Official
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Title or Position | PRESIDENT
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Name | JONATHAN DANIEL CASCIANO
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Credential | M.D.
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Telephone | 501-661-1123
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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 |
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