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NPI Code Detail

MEDICARE: DR. PENNY FRESHOUR O.D.

MEDICARE: DR. PENNY FRESHOUR 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
1152W00000XOptometristAR2483AR

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2P00273197OTHERARRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
119983000040OTHERARQUALCHOICE
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4AR2483OTHERARAR LICENSE

General Provider Information

NPI Number : 1518016435
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. PENNY FRESHOUR O.D.
Provider Business Mailing Address
First Line : 900 S BOWMAN RD
Second Line :
City : LITTLE ROCK
State : AR
Zip : 72211-3617
Country : US
Telephone Number : 501-904-5009
Fax Number : 501-217-8679
Provider Business Practice Location Address
First Line : 900 S BOWMAN RD
Second Line :
City : LITTLE ROCK
State : AR
Zip : 72211-3617
Country : US
Telephone Number : 501-904-5009
Fax Number : 501-217-8679
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/09/2007
Last Update Date : 11/07/2018

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