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NPI Code Detail

MEDICARE: SUCCESS VISION EXPRESS OF HOT SPRINGS, LLC

MEDICARE: SUCCESS VISION EXPRESS OF HOT SPRINGS, LLC
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
1332H00000XEyewear SupplierL920802AR

General Provider Information

NPI Number : 1356886360
Entity Type Code : Organization
Provider Name (Legal Business Name) : SUCCESS VISION EXPRESS OF HOT SPRINGS, LLC
Provider Business Mailing Address
First Line : 5312 W 41ST ST
Second Line :
City : TULSA
State : OK
Zip : 74107-6110
Country : US
Telephone Number : 918-895-1700
Fax Number :
Provider Business Practice Location Address
First Line : 4043 CENTRAL AVE
Second Line : STE A
City : HOT SPRINGS
State : AR
Zip : 71913-7208
Country : US
Telephone Number : 501-701-2020
Fax Number :
Authorized Official
Title or Position : INSURANCE MANAGER
Name : DOUG WOOLERY
Credential :
Telephone Number : 918-895-1700
Provider Enumeration Date : 12/29/2016
Last Update Date : 12/29/2016

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Directions to “SUCCESS VISION EXPRESS OF HOT SPRINGS, LLC ” Practice Location

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