MEDICARE: DR. CLEMIT W LILES III O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	2626	AR

General Provider Information

NPI Number	:	1003044355
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CLEMIT W LILES III O.D.

Provider Business Mailing Address
First Line	:	17569 FISHTRAP RD STE 30
Second Line	:
City	:	PROSPER
State	:	TX
Zip	:	75078-5122
Country	:	US
Telephone Number	:	469-715-0775
Fax Number	:

Provider Business Practice Location Address
First Line	:	2425 S ZERO ST
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72901-8663
Country	:	US
Telephone Number	:	479-763-1230
Fax Number	:	479-777-4614

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/25/2009
Last Update Date	:	11/28/2023

Similar Medicare Providers

1154348530 — WALMART INC.
Practice Location Address:

2425 S ZERO ST
FORT SMITH, AR
72901-8663

Practice Phone: 479-646-4983
Practice Fax: 479-646-5088

1215010798 — WAL-MART STORES, INC.
Practice Location Address:

2425 ZERO ST
FORT SMITH, AR
72901-8663

Practice Phone: 479-646-6382
Practice Fax:

1972673432 — CHARLES GIBSON O.D.
Practice Location Address:

2425 ZERO ST
FORT SMITH, AR
72901-8663

Practice Phone: 479-649-5900
Practice Fax: 479-649-6724

1790308849 — DR. LEANN LEA PHARMD
Practice Location Address:

2425 S ZERO ST
FORT SMITH, AR
72901-8663

Practice Phone: 479-646-4983
Practice Fax:

1477153690 — DR. TERRI DART PHARMD
Practice Location Address:

2425 S ZERO ST
FORT SMITH, AR
72901-8663

Practice Phone: 479-646-4983
Practice Fax:

1124629621 — ALISON THOMAS PHARMD
Practice Location Address:

2425 S ZERO ST
FORT SMITH, AR
72901-8663

Practice Phone: 479-646-4983
Practice Fax: 479-646-5088

Directions to “ DR. CLEMIT W LILES III O.D.” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.