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NPI Code Detail

MEDICARE: DR. CASEY ROYCE DILLARD O.D.

MEDICARE:  DR. CASEY ROYCE DILLARD  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
1152W00000XOptometrist2718AR

General Provider Information

NPI Number : 1487033759
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CASEY ROYCE DILLARD O.D.
Provider Business Mailing Address
First Line : 467460 E 1070 RD
Second Line :
City : SALLISAW
State : OK
Zip : 74955-7116
Country : US
Telephone Number : 918-208-7257
Fax Number :
Provider Business Practice Location Address
First Line : 4189 PHOENIX AVE
Second Line :
City : FORT SMITH
State : AR
Zip : 72903-6013
Country : US
Telephone Number : 479-434-4668
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/20/2015
Last Update Date : 07/06/2015

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Directions to “ DR. CASEY ROYCE DILLARD O.D.” Practice Location

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