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General NPI Number Information
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NPI Number | 1669744371
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Entity Type | Organization
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Legal Business Name | THE EYE DOCTOR LLC
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Dates
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Enumeration Date | 01/27/2012
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Last Update Date | 01/27/2012
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Provider Practice Location Address
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Address Line | 9300 BROCKINGTON RD
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City | SHERWOOD
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State | AR
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Zip | 72120
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Country | US
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Telephone | 501-753-3000
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Fax | 501-833-8311
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Provider Business Mailing Address
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Address Line | 9300 BROCKINGTON RD
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City | SHERWOOD
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State | AR
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Zip | 72120
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Country | US
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Telephone | 501-753-3000
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Fax | 501-833-8311
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Authorized Official
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Title or Position | OFFICER
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Name | DR. KYMBERLY V DEVITT
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Credential | O.D.
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Telephone | 501-766-4488
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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 | AR2413
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License Number State | AR
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