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General NPI Number Information
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NPI Number | 1568083400
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Entity Type | Organization
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Legal Business Name | BRENDON COX OD, LLC
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Dates
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Enumeration Date | 05/01/2020
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Last Update Date | 05/01/2020
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Provider Practice Location Address
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Address Line | 68 E MAIN ST
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City | FARMINGTON
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State | AR
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Zip | 72730-3110
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Country | US
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Telephone | 479-255-1010
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Fax | 479-255-1032
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Provider Business Mailing Address
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Address Line | 18688 N CREEK RD
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City | LINCOLN
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State | AR
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Zip | 72744-8609
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Country | US
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Telephone | 417-489-5318
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Fax |
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Authorized Official
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Title or Position | INCORPORATOR/OFFICER
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Name | DR. BRENDON WARD COX
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Credential | OD
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Telephone | 417-489-5318
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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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