Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 2050 | AR |
NPI | 1003920653 |
---|---|
Provider Name | Dr. Harry R Denison |
First Address | Fordyce, AR 71742-0725 |
Second Address | Fordyce, AR 71742-3318 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/08/2006 |
Last Update Date | 22/05/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
102066722 | (05) | AR |
T20220 | (02) | AR |