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General NPI Number Information
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NPI Number | 1447307095
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Entity Type | Individual
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Provider Name | MIKE TANNEHILL OD
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Gender | Male
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Dates
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Enumeration Date | 01/05/2007
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Last Update Date | 08/21/2020
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Provider Practice Location Address
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Address Line | 138 S GEORGE ST
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City | MT IDA
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State | AR
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Zip | 71957-9999
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Country | US
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Telephone | 870-867-2814
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 215
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City | MOUNT IDA
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State | AR
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Zip | 71957-9999
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Country | US
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Telephone | 870-867-2814
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Fax |
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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 | 2190
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License Number State | AR
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