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General NPI Number Information
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NPI Number | 1427033596
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Entity Type | Individual
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Provider Name | DANIEL J HENNESSEY III OD
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Gender | Male
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Dates
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Enumeration Date | 12/13/2005
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Last Update Date | 10/15/2019
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Provider Practice Location Address
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Address Line | 4200 N. RODNEY PARHAM ROAD SUITE 101
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City | LITTLE ROCK
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State | AR
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Zip | 72212
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Country | UM
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Telephone | 501-224-5658
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Fax | 501-687-0801
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Provider Business Mailing Address
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Address Line | 201 EXECUTIVE CT SUITE A
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City | LITTLE ROCK
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State | AR
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Zip | 72205-4536
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Country | US
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Telephone | 501-224-5658
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Fax | 501-224-8114
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 2322
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License Number State | AR
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