Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152WC0802X | Optomitrist - Corneal and Contact Lenses | 2476 | AR |
NPI | 1275619876 |
---|---|
Provider Name | Dr. Charles L Todd |
First Address | Conway, AR 72034-5325 |
Second Address | Conway, AR 72034-5325 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/10/2006 |
Last Update Date | 18/08/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
134909722 | (05) | AR |
U71198 | (02) | AR |