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General NPI Number Information
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NPI Number | 1669651311
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Entity Type | Organization
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Legal Business Name | BENTON EYECARE CLINIC
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Dates
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Enumeration Date | 10/30/2007
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Last Update Date | 06/24/2020
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Provider Practice Location Address
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Address Line | 443 HIGHWAY 5 N
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City | BENTON
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State | AR
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Zip | 72019-9778
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Country | US
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Telephone | 501-778-2020
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Fax | 501-778-1788
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Provider Business Mailing Address
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Address Line | 11225 HURON LN STE 200A
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City | LITTLE ROCK
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State | AR
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Zip | 72211-1861
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Country | US
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Telephone | 501-778-2020
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Fax | 501-778-1788
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Authorized Official
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Title or Position | PARTNER/PROVIDER
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Name | TASKER RODMAN
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Credential |
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Telephone | 501-225-9944
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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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