MEDICARE: DAVID AND DEANNE WITHERSPOON, OPTOMETRY, P.A.

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	2313	AR

General Provider Information

NPI Number	:	1851460430
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAVID AND DEANNE WITHERSPOON, OPTOMETRY, P.A.

Provider Business Mailing Address
First Line	:	5212 VILLAGE PKWY
Second Line	:	SUITE 6
City	:	ROGERS
State	:	AR
Zip	:	72758-8104
Country	:	US
Telephone Number	:	479-464-9702
Fax Number	:

Provider Business Practice Location Address
First Line	:	5212 VILLAGE PKWY
Second Line	:	SUITE 6
City	:	ROGERS
State	:	AR
Zip	:	72758-8104
Country	:	US
Telephone Number	:	479-464-9702
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DAVID E WITHERSPOON
Credential	:	O.D.
Telephone Number	:	479-464-9702

Provider Enumeration Date	:	11/07/2006
Last Update Date	:	08/25/2007

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