MEDICARE: BROOKE HOUSER

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	2790	AR
2	152W00000X	Optometrist	9447T	TX
3	152W00000X	Optometrist	2985	OK

General Provider Information

NPI Number	:	1780188193
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BROOKE HOUSER

Provider Business Mailing Address
First Line	:	6210 MASSARD RD STE 103
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72916-5042
Country	:	US
Telephone Number	:	479-353-5833
Fax Number	:	479-358-1435

Provider Business Practice Location Address
First Line	:	6801 ROGERS AVE FL 5
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72903-4067
Country	:	US
Telephone Number	:	479-274-4400
Fax Number	:

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

Provider Enumeration Date	:	03/20/2018
Last Update Date	:	12/02/2025

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Directions to “ BROOKE HOUSER ” Practice Location

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