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
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