Organization
MOULTON OPTICAL DEPARTMENT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. EVERETT CROCKETT MOULTON III M.D. (PRESIDENT)
(479) 646-3937
Entity
Organization
Contact information
Practice address
5518 ELLSWORTH RD, FORT SMITH, AR 72903-3222
(479) 646-3937
(479) 646-3605
Mailing address
5518 ELLSWORTH RD, FORT SMITH, AR 72903-3222
(479) 646-3937
(479) 646-3605
Taxonomy
Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
C4990
AR
Other
Enumeration date
04/24/2008
Last updated
01/24/2019
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