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General NPI Number Information
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NPI Number | 1992976039
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Entity Type | Organization
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Legal Business Name | WILLIAM C. WYATT, O.D., P.A.
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Dates
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Enumeration Date | 03/17/2008
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Last Update Date | 03/17/2008
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Provider Practice Location Address
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Address Line | 204 N THOMASVILLE AVE
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City | POCAHONTAS
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State | AR
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Zip | 72455-2665
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Country | US
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Telephone | 870-892-9169
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Fax | 870-892-4031
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Provider Business Mailing Address
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Address Line | 204 N THOMASVILLE AVE
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City | POCAHONTAS
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State | AR
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Zip | 72455-2665
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Country | US
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Telephone | 870-892-9169
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Fax | 870-892-4031
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | DR. WILLIAM C. WYATT
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Credential | O.D.
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Telephone | 870-892-9169
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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 | 2210
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License Number State | AR
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