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General NPI Number Information
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NPI Number | 1972660595
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Entity Type | Organization
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Legal Business Name | DOROTHY HARRIS
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Dates
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Enumeration Date | 01/02/2007
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Last Update Date | 07/24/2008
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Provider Practice Location Address
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Address Line | 3073 W 28TH AVE
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City | PINE BLUFF
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State | AR
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Zip | 71603-4802
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Country | US
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Telephone | 870-534-8184
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Fax | 870-534-8184
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Provider Business Mailing Address
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Address Line | 3073 W 28TH AVE
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City | PINE BLUFF
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State | AR
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Zip | 71603-4802
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Country | US
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Telephone | 870-534-8184
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Fax | 870-534-8184
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Authorized Official
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Title or Position | MANAGER
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Name | FAYE WEST
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Credential |
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Telephone | 870-534-8184
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | L8837
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License Number State | AR
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