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General NPI Number Information
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NPI Number | 1902279409
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Entity Type | Organization
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Legal Business Name | WELLS FAMILY EYECARE PA
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Dates
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Enumeration Date | 11/05/2015
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Last Update Date | 11/05/2015
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Provider Practice Location Address
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Address Line | 804 MEDICAL DR
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City | MANILA
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State | AR
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Zip | 72442-8305
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Country | US
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Telephone | 870-570-0400
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Fax | 870-570-0402
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Provider Business Mailing Address
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Address Line | 804 MEDICAL DR
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City | MANILA
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State | AR
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Zip | 72442-8305
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Country | US
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Telephone | 870-570-0400
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Fax | 870-570-0402
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Authorized Official
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Title or Position | OWNER
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Name | DR. CHRISTY MICHELLE CLARK-WELLS
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Credential | O,D,
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Telephone | 870-570-0400
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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 | 2616
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License Number State | AR
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