Alan L Latourette Estate Vicki C Latourette Ex
Organization Active NPI Optometrist · Rogers, AR
NPI 1992014526 · NPPES record last updated Mar 29, 2011
Key facts
- NPI
- 1992014526
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Optometrist 152W00000X
- Legal business name
- ALAN L LATOURETTE ESTATE VICKI C LATOURETTE EX
- Practice address
- 1401 W Walnut St
Rogers, AR 72756-3317 - Phone
- (479) 636-2012
- Fax
- (479) 631-7416
- NPI assigned
- Sep 30, 2010
- Organization subpart
- No
Authorized official
- Name
- Mrs. Vicki C Latourette
- Title
- Executrix of Alan Latourette Estate
- Phone
- (479) 636-2012
National Provider Directory
Locations
1401 W Walnut St
Rogers, AR 72756
Phone (479) 636-2012
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist |
152W00000X | Yes |
Addresses
Primary practice location
1401 W Walnut St
Rogers, AR 72756-3317
Mailing address
1401 W Walnut St
Rogers, AR 72756-3317
Phone (479) 636-2012
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 185799722 | Medicaid | AR |
Other names
- Tri State Optical Center
Other providers in Rogers, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 29, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.