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General NPI Number Information
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NPI Number | 1871778142
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Entity Type | Organization
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Legal Business Name | BRIGGS VISION CLINIC
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Dates
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Enumeration Date | 01/07/2008
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Last Update Date | 10/07/2011
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Provider Practice Location Address
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Address Line | 745 E JOYCE BLVD STE 124
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City | FAYETTEVILLE
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State | AR
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Zip | 72703
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Country | US
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Telephone | 479-582-9119
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Fax |
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Provider Business Mailing Address
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Address Line | 745 E JOYE BLVD STE 124
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City | FAYETTEVILLE
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State | AR
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Zip | 72703
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Country | US
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Telephone | 479-582-9119
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Fax | 479-273-5947
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MARK BRIGGS
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Credential | OD
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Telephone | 479-582-9119
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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 | AR2486
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License Number State | AR
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