Individual
DR. JERRY H ELLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
197 HOSPITAL DRIVE, SUITE A, CHEROKEE VILLAGE, AR 72529-7315
(870) 257-2100
(870) 257-4395
Mailing address
197 HOSPITAL DRIVE, SUITE A, CHEROKEE VILLAGE, AR 72529-7315
(870) 257-2100
(870) 257-4395
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2408
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
128855722
—
AR
Enumeration date
12/13/2006
Last updated
12/07/2009
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