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General NPI Number Information
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NPI Number | 1730139692
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Entity Type | Individual
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Provider Name | JIM DUDLEY OD
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Gender | Male
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Dates
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Enumeration Date | 05/11/2006
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Last Update Date | 02/14/2014
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Provider Practice Location Address
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Address Line | 112 COUNTY 301
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City | EUREKA SPRINGS
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State | AR
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Zip | 72632-9192
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Country | US
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Telephone | 479-445-0317
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Fax | 479-253-9479
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Provider Business Mailing Address
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Address Line | 112 COUNTY 301
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City | EUREKA SPRINGS
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State | AR
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Zip | 72632-9192
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Country | US
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Telephone | 479-445-0317
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Fax | 479-253-9479
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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 | 2261
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License Number State | AR
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