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General NPI Number Information
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NPI Number | 1780776518
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Entity Type | Organization
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Legal Business Name | BRYANT EYECARE CLINIC
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Dates
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Enumeration Date | 09/29/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2900 HORIZON DR STE 14
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City | BRYANT
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State | AR
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Zip | 72022-9095
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Country | US
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Telephone | 501-653-2020
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Fax |
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Provider Business Mailing Address
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Address Line | 2900 HORIZON DR STE 14
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City | BRYANT
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State | AR
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Zip | 72022-9095
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Country | US
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Telephone | 501-653-2020
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | TINA D BROWN
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Credential |
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Telephone | 501-653-2020
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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 | 2504
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License Number State | AR
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