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General NPI Number Information
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NPI Number | 1912570920
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Entity Type | Organization
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Legal Business Name | FAYETTEVILLE FAMILY EYE CARE
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Dates
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Enumeration Date | 07/19/2021
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Last Update Date | 01/04/2022
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Provider Practice Location Address
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Address Line | 3919 N MALL AVE
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City | FAYETTEVILLE
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State | AR
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Zip | 72703-4906
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Country | US
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Telephone | 479-339-1116
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Fax | 479-339-1106
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Provider Business Mailing Address
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Address Line | 980 SILVER MAPLE ST
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City | CENTERTON
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State | AR
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Zip | 72719-7047
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Country | US
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Telephone | 903-306-8704
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Fax |
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Authorized Official
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Title or Position | OWNER/OPTOMETRIST
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Name | DR. MATTHEW HOWELL
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Credential | OD
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Telephone | 479-339-1116
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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 |
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License Number State |
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