Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 2249 | AR |
NPI | 1003876582 |
---|---|
Provider Name | Dr. Charles Floyd Hyman |
First Address | West Memphis, AR 72301-2613 |
Second Address | West Memphis, AR 72301-2613 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/03/2006 |
Last Update Date | 31/03/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
49065 | BCBS (01) | AR |
53000 | SPECTERA (01) | AR |
T20270 | (02) | AR |