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General NPI Number Information
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NPI Number | 1801345426
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Entity Type | Organization
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Legal Business Name | THE EXCLUSIVE EYE, PLLC
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Dates
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Enumeration Date | 09/23/2016
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Last Update Date | 11/10/2022
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Provider Practice Location Address
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Address Line | 1810 N COLLEGE AVE STE 110
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City | FAYETTEVILLE
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State | AR
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Zip | 72703-2607
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Country | US
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Telephone | 479-903-7393
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Fax | 479-802-6204
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Provider Business Mailing Address
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Address Line | 1810 N COLLEGE AVE STE 110
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City | FAYETTEVILLE
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State | AR
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Zip | 72703-2607
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Country | US
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Telephone | 479-903-7393
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Fax | 479-802-6204
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | DR. JESSICA L DINWIDDIE
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Credential | O.D.
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Telephone | 479-305-1571
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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 | 2662
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License Number State | AR
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