| |
29 River Road Dr E, Mayflower, AR 72106-8409 | |
(501) 328-9500 | |
(501) 328-5148 |
Full Name | |
---|---|
Type | Facility |
Speciality | Optometrist |
Location | 29 River Road Dr E, Mayflower, Arkansas |
Accepts Medicare Assignments | Does not participate in Medicare Program. The facility may not accept medicare assignment. |
Identifier | Type | State | Issuer |
---|---|---|---|
1700194990 | NPI | - | NPPES |
106399722 | Medicaid | AR | |
5G617 | Other | AR | MEDICARE PTAN |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
152W00000X | Optometrist | 2272 (Arkansas) | Primary |
Mailing Address | Practice Location Address |
---|---|
1155 Hwy 65 North, Conway, AR 72032 Ph: (501) 328-9500 | 29 River Road Dr E, Mayflower, AR 72106-8409 Ph: (501) 328-9500 |