Organization
ENNEN EYE CENTER, P.A.
Active
Organization
ENNEN EYE CENTER, P.A.
Active
Other names
Ennen Eye Center
Organization subpart
No
Provider details
NPI number
Authorized official
RANDY M. ENNEN M.D. (PRESIDENT)
(479) 452-7800
Entity
Organization
Contact information
Practice address
3312 S 70TH ST, FORT SMITH, AR 72903-5052
(479) 452-7800
(479) 452-9486
Mailing address
3312 S 70TH ST, FORT SMITH, AR 72903-5052
(479) 452-7800
(479) 452-9486
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
—
—
207W00000X
Ophthalmology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100177380B
—
OK
05
—
152215002
—
AR
Enumeration date
03/29/2006
Last updated
04/12/2012
Update your record
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