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General NPI Number Information
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NPI Number | 1467590950
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Entity Type | Organization
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Legal Business Name | AMY J S DAIBER OD PA
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Dates
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Enumeration Date | 02/05/2007
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Last Update Date | 05/18/2009
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Provider Practice Location Address
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Address Line | 204 N FRONT ST DAIBER VISION CARE
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City | DARDANELLE
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State | AR
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Zip | 72834-3824
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Country | US
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Telephone | 479-967-6113
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Fax | 479-968-6932
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Provider Business Mailing Address
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Address Line | 204 N FRONT ST
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City | DARDANELLE
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State | AR
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Zip | 72834-3824
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Country | US
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Telephone | 479-229-1467
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Fax | 479-229-1260
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. AMY JEANINE DAIBER
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Credential | OD
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Telephone | 479-967-6113
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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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