=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538058219
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SOUTHWEST ARKANSAS EYE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/30/2025
-----------------------------------------------------
Last Update Date | 07/07/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2733 CADDO ST
-----------------------------------------------------
City | ARKADELPHIA
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 71923-5309
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 870-845-5211
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 193 STAGGS DR
-----------------------------------------------------
City | NASHVILLE
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 71852-9618
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 870-557-6641
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OPTOMETRIST/OWNER
-----------------------------------------------------
Name | CHRISTOPHER AARON TOLLETT
-----------------------------------------------------
Credential | OD
-----------------------------------------------------
Telephone | 870-557-6641
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------