Moulton Optical Department

Primary specialty

Eyewear SupplierTaxonomy code 332H00000X

License

C4990 Issued in AR

Legal business name

MOULTON OPTICAL DEPARTMENT

Practice address

5518 Ellsworth Rd
Fort Smith, AR 72903-3222

Phone

(479) 646-3937

Fax

(479) 646-3605

NPI assigned

Apr 24, 2008

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Everett Crockett Moulton III, M.D.

Title

President

Phone

(479) 646-3937

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1208995200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1548288000000",
    "number": "1235304924",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5518 ELLSWORTH RD",
            "city": "FORT SMITH",
            "state": "AR",
            "postal_code": "729033222",
            "telephone_number": "479-646-3937",
            "fax_number": "479-646-3605"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5518 ELLSWORTH RD",
            "city": "FORT SMITH",
            "state": "AR",
            "postal_code": "729033222",
            "telephone_number": "479-646-3937",
            "fax_number": "479-646-3605"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOULTON OPTICAL DEPARTMENT",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-24",
        "last_updated": "2019-01-24",
        "status": "A",
        "authorized_official_last_name": "MOULTON",
        "authorized_official_first_name": "EVERETT",
        "authorized_official_middle_name": "CROCKETT",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "479-646-3937",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "III",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": "AR",
            "license": "C4990",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Zachary J Moss, MHPP
• Rachel R Mote
• Bethany Mott
• James Mott, QBHP
• Thomas Mottl, DO
• Luke Mountz, DPT
• Kayla Michelle Moury, PA-C
• Charles Moussallem, M.D
• Mt Hope Counseling Centers, Inc
• Candice D Mulac

• Eyewear Supplier in Fort Smith, AR
• Providers in Fort Smith, AR by specialty
• Eyewear Supplier in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.