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General NPI Number Information
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NPI Number | 1497627400
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Entity Type | Organization
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Legal Business Name | IIII OPTICAL - DOG TOWN LLC
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Dates
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Enumeration Date | 09/19/2025
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Last Update Date | 09/19/2025
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Provider Practice Location Address
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Address Line | 312 W PERSHING BLVD
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City | NORTH LITTLE ROCK
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State | AR
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Zip | 72114-2224
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Country | US
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Telephone | 501-830-2020
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Fax |
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Provider Business Mailing Address
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Address Line | 10700 N RODNEY PARHAM RD STE C2
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City | LITTLE ROCK
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State | AR
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Zip | 72212-4159
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Country | US
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Telephone | 501-830-2020
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | BYRON N WILKES
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Credential | MD
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Telephone | 501-830-2020
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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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