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General NPI Number Information
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NPI Number | 1619111762
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Entity Type | Individual
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Provider Name | KELSEY BLOCH LIVENGOOD O.D.
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Gender | Female
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Dates
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Enumeration Date | 04/20/2009
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Last Update Date | 01/10/2014
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Provider Practice Location Address
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Address Line | 32 S PINE ST SUITE 1
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City | CABOT
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State | AR
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Zip | 72023-3830
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Country | US
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Telephone | 713-306-2422
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 28 CABOT FAMILY CARE
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City | CABOT
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State | AR
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Zip | 72023-0028
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Country | US
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Telephone | 713-306-2422
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Fax | 501-843-2599
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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 | 2889
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 2640
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License Number State | AR
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